Case history-6

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22 years old female daily wage labourer by occupation presented to the opd with c/o pain and swelling in left lower limb since 1 month .

HISTORY OF PRESENT ILLNESS:

Patient was apparantly asymptomatic 1year ago then she had  round skin lesions which are associated with itching then they went to local doctor and used some topical ointment for period of 3-4 months patient did not get any relief so they again went to doctor then patient was prescribed with Avil and Decadran injections and patient used them for a period of 3-4 months even then patient did not got relieved from her skin lesions and then she came to our hospital and here she was given Itraconazole later her skin lesions got subsided . 3 months ago then she had fever then she underwent some investigations and was found to be diabetic and was on medication TAB.METFORMIN 500MG 

History of pain in the left lower limb since 1 month denies history of trauma later on swelling appeared which got burst with pus discharge and had underwent aseptic dressing for 1 week later it got progressed and patient is unable to walk due to pain .

History of fever since 1-2 weeks on and off subsiding on taking medication , it is associated with nausea and no h/o vomiting ,loose stools .

History of facial puffiness since 3 months .

Decreased urine output since 1 month .

She underwent LSCS  due to delayed labour .

Patient is a known case of DM since 3 months on tab metformin 500mg and inj. Mixtard 6u

Not a known case of  HTN, Asthma, Epilepsy , TB, CAD.

 

PERSONAL HISTORY:

Diet :Mixed 

Appetite : decreased

Bowels : c/o Constipation

Micturition : Decreased urine output .

No known allergies 

No significant family history .

GENERAL EXAMINATION:

Patient is conscious , coherant, cooperative.

No icterus 

No cyanosis 

No clubbing

No lymphadenopathy.

Unilateral left lower limb edema pitting type .

VITALS :

Temp: 98.6 

BP- 100/70 mmhg

PR- 92/min

RR- 18/ min 

Spo2- 98%

Grbs- 372mg%

SYSTEMIC EXAMINATION :

CVS - S1,S2 +

RS - BAE+

P/A- SOFT , NON TENDER ,BOWEL SOUNDS +

CNS - NO FOCAL NEUROLIGICAL DEFICITS 

PROVISNAL DIAGNOSIS :

 Iatrogenic Cushing's with h/o tenia corporis 

Patient is a known case of taenia corporis 

Left lower limb cellulitis with uncontrolled diabetes mellitus

TREATMENT

- IVF - NS , RL @100ML/HR

- INJ. PAN 40MG IV OD BBF

- INJ . NEOMOL 1GM IV SOS 

- INJ.HAI S/C TID 

- TAB. DOLO 650MG PO SOS 

- SYP . POTCHLOR 10 ML PO IN 1 GLASS OF WATER TID.

INVESTIGATIONS:

FEVER CHART:

ECG:

CHEST XRAY VIEW: