GENERAL MEDICINE E LOG BOOK
17 YEAR OLD BOY PRESENTED WITH ABDOMINAL DISTENSION AND WEIGHT GAIN
November 30 , 2021
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done on 24/11/21
done on 23/11/21
done on 23/11/21
ECG report
Patient was referred to ophthalmologist for visual acuity testing and fundoscopy for raised IOP
Medication Chart
On 29/11/21
Fever chart
ARUSHI KUMARI
Roll no. 151
17 year old boy presented to the OPD on 24/11/21 at 11:48 a.m with chief complain of
- Itchy ring lesion over upper limb , lower limb , abdomen , lower back and thigh since 1 year
- abdominal distension since 6 months
- facial puffiness since 6 months
- pedal edema since 3 month
- lower back pain since 3 months
- low mood and refusing to meet anyone
History of Presenting Illness
Patient was apparently asymptomatic 1 year ago after which he gradually developed erythematous round lesion which are itchy and distributed all over upper limb , groin region , abdomen and inner thigh .
The lesion were aggrevated whenever the patient go out in hot sunny climate and patient get burning sensation on scratching .
Patient is constantly depressed and has low mood . Patient attender is complaining that the patient is not going out of house and is staying in home constantly . On asking about it patient says he feels bad about his appearance .
Features of hirsutism and decreased libido.
Past History
- weight gain since 6 months ( from 63 kg to 74 kg )
- Patient visited local RMP where he was prescribed some herbal medicine which he had taken for 6 months .
Patient started noticing pink striae over his abdomen and later on back and over arms which gradually increased in size .
There was increase in size of striae over abdomen since 1 month .
He also observed abdominal distension , facial puffiness , weight gain and pedal edema with associated low back pain since 3 months .
Patient was advised to consult dermatologist .
The dermatologist diagnosed it as a case of Tinea cruris et corporis + Striae Rubra and started medication as such .
LULIFIN CREAM OD * 2 weeks
EBERNET PLUS CREAM L/A OD * 2 weeks
TAB SEBIFIN 250 mg OD * 2 weeks
T - BACT OINTMENT L/A B/O * 1 week
TAB ATARAX 25 mg OD * 5 days
- Known case of HTN
On T. TELMA AM 40 mg Po/OD
Personal History
Mixed diet
Normal appetite
Ball and bladder movement regular
Normal micturition - no burning sensation
No known allergies
No addiction
General Examination
Pallor - absent
Icterus - absent
No cyanosis
No clubbing
No lymphadenopathy
Pedal edema present ( non pitting type )
Temp. - 97.8 F
Pulse rate - 78/min
Respiratory rate - 17 cpm
BP - 140/90
SPO2 - 99 per cent
GRBS - 108 mg
CVS - S1,S2 heard
RS - BAE + , NVBS heard
Per Abdomen - distended abdomen
- Soft , non-tender
- Liver and spleen non palpable
- Superficial vein seen on abdomen
** Superficial vein on Abdomen indicate skin atrophy which is classical of Cushing syndrome .
INVESTIGATIONS
CLINICAL IMAGES
Provisional Diagnosis
Iatrogenic Cushing Syndrome
Adrenal insufficiency ??
Tinea Corporis and Cruris
Treatment
Salt restricted diet
Carbohydrate restricted diet
T. TELMA AM 40/5 mg / PO / OD
T. ATARAX 25 mg PO/OD * 5 days
T. SEBIFIN 250 mg PO/OD * 2 weeks
EBERNET PLUS CREAM L/A OD * 2 weeks
T - BACT OINTMENT L/A BD * 2 weeks
LULIFIN CREAM L/A OD * 2 weeks
Inj. HYDROCORTISONE 100 mg i.v ( only if patient is in shock , hypotension, hypoglycemia )
T. SHELCAL 500 mg PO/OD
T . METFORMIN 500 mg PO/OD stopped
T. NICARDIA 10 mg /SOS
IATROGENIC CUSHING SYNDROME
ADRENAL INSUFFICIENCY ??
known case of HTN
Tinea Corporis and Cruris
I would like to thank intern ma'am for giving me an opportunity to go through this case .
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