DERMATOMYOSITIS

 This is an E log book to discuss our patients de identified health data shared after guardians informed consent.

Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve this patients clinical problems with collective current best evidence based inputs.

This E-book also reflects my patients centered online learning portfolio and your valuable comments in comment box are most welcome.

Details of patient when admitted 2 months back in a health centre in the below link:

https://rhea9895.blogspot.com/2022/01/29-years-old-female-with-co-joint-pains.html

Reference of this blog: Reference:https://nikitha0510.blogspot.com/2022/03/dermatomyositis.html?m=1)

I have been given this case to solve in an attempt to understand the topic of "patient clinical analysis" to develop my competency and to comprehend clinical data including history, clinical finding investigations and come up with a diagnosis and treatment plan.

Chief complaints:

Fever since 4 days 

Cough since 4 days

B/L joint pains associated with pedal oedema since 4 days 

Dyspnoea since 3 days 

HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic 12 months ago. 

 Then she developed symmetrical b/l joint pains in the knees which was insidious in on set, gradually progressive, no aggravating factors and relieved on medication

she developed itching over neck and upper chest area and due to over it hing at the location it turned black.

(Reference:https://nikitha0510.blogspot.com/2022/03/dermatomyositis.html?m=1)

 Alopecia since 12 months associated with pain,

Also had malar rash which was initially erythematousbut later became hyperpigmented.

 vaginal discharge since 10 months. It was initially curdy white which later changed to watery discharge

Difficulty in walking.distal muscle weakness

She also had difficulty in breathing at rest since 3 days.which was gradually progressing

. She also complained of pins and needles sensation in the palms and thighs.

.

PAST HISTORY

No H/O DM, HTN, asthma, epilepsy, CAD

Personal history:

Diet ;mixed 

Sleep adequate

Bowel,bladder  habits regular.

Addictions none.

 

Menstrual history:

Menarche: 11 year

Cycle lasts: 26-28 days

3 days of menstruation

Regular cycles

She also had vaginal discharge. 

No pains or clots:

MARITAL HISTORY

She is married but doesn't have any kids, she has adopted a girl from her sister in law

She has primary infertility.

GENERAL EXAMINATION 

The patient was conscious, coherent, cooperative, well oriented to time, place, person. She was moderately built and moderately nourished

Pallor: Present

No icterus, cyanosis, clubbing, lymphadenopathy 

Pedal edema: present 

VITALS: 

Temperature: afebrile.

BP: 150/100 mm Hg

PR: 114 bpm

RR: 30 cpm

SYSTEMIC EXAMINATION

CVS - S1, S2 hear

RS: BAE +

P/A: soft, non tender

CNS: NA

Investigation:

They performed a ANTI NUCLEAR ANTIBODY immunofluorescence which showed

Homogeneous pattern. Intensity 4+ the assosiated antigens involved are: dsDNA, Histones.

They also performed an HRCT which showe

: few patchy areas of ground glass opacities in peri bronchovascular distribution- s/o pneumonitis 

Chest xray.:

PROVISIONAL DIAGNOSIS

DERMATOMYOSITIS with candidiasis.

TREATMENT:

1.T.SEPTRAN DS TID 

2.TAB.FLUCONAZOLE 150 MG OD 

3.OINT.CANDID.

4.TAB.WYSOLONT 50 MG OD 

5.TAB.FOLIC ACID 5 MG ONCE A WEEK.

Images after 2 months of treatment:

Present images.:

Key points:

Heliotropic rash : diffuse erythematous hyperpigmented motted patch.

Shawl sign: rash extended upto neck and back.

Holsier sign: macule on the groin.

Gotrin papules: pigmentation on knuckles.