GENERAL MEDICINE CASE DISCUSSION
SUPRIYA GAGIREDDY 42
Hi,I am supriya 5th sem medical student.This is an online elog book to discuss our patients de-identified health data shared after taking his/her/guardians signed informed consent.Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.This E-log book reflects my patient centered online learning portfolia.
Patient is referred from Dermatology department.
A 66 year old male patient from Kakkereni, AP Lingotam, Shepherd by occupation came to the OPD with
CHIEF COMPLAINTS:
Multiple painful blisters all ove the body sparing palms and soles.
History Of Presenting Illness
Patient was apparently asymptomatic 5 years ago then he started developing itching all over the body suddenly which subsides temporarily on applying Vaseline.
5 days ago he developed a blister on the dorsal surface of the middle distal phalynx of his left hand following which his body started itching and blisters started appearing on his body starting from the periphery spreading to the trunk which were painful. It was associated with fever but cured immediately on taking medication. The blisters are rupturing spontaneously and serosanguinous fluid is oozing out of the ruptured blister.
Past history
He had no similar complaints in the past.
K/c/o Diabetes mellitus since 5 years and Hypertension since 3 years and is on medication with Telmesartan and Metformin respectively.
Not a k/c/o Tuberculosis, Asthma, Epilepsy, CAD.
Has a history of allergy to few vegetables like Egg plant, potato.
Personal history
Diet - Mixed
Appetite - Normal
Sleep - Inadequate due to painful blisters
Bowel and bladder movements - Regular
Addictions - Occasional Alcoholic
Family history - No other family members have similar complaints.
Drug history - Metformin for Diabetes since 5 years and Telmesartan for Hypertension since 3 years.
General physical examination
Patient is conscious, coherent and cooperative
Moderately built and moderately nourished
No Pallor, Icterus, Cyanosis, Clubbing, Generalised lymphadenopathy, Pedal edema
Vitals
Temperature - Afebrile
Pulse rare - 76 bpm
Respiratory rate - 18 cpm
Blood pressure - 120/80 bpm
Skin - Multiple bullae and pustules over B/L upper and lower limbs, trunk, buttocks and one on distal phalynx with erosions, crusting and oozing blood and serous fluid.
Systemic examination
CVS - S1, S2 heard
Respiratory system - BAE present
Abdomen - Soft, Non tender
CNS - No focal neurological deficits.
Provisional diagnosis
Bullous Pemphigoid?
Investigations
Culture and sensitivity of pustule
CBP, FBS, CUE, PLBS, LFT, RFT.
Treatment
Cap. AMOXICILLIN 625mg BD
FUDIC CREAM BD
Tab. ATARAX 10mg OD
Tab. DOLO 650mg BD 3x days
Inj. HAI premeal SC/TID
GRBS monitoring
Strict Diabetes control
Differential diagnosis
Bullous Pemphigoid
Bullous Impetigo
Folliculitis + Acute Paronychia
Eczema with secondary bacterial infection
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