GENERAL MEDICINE E LOG BOOK

17 YEAR OLD BOY PRESENTED WITH ABDOMINAL DISTENSION AND WEIGHT GAIN 

November 30 , 2021 

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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







                 done on 24/11/21

                   done on 23/11/21

                  done on 23/11/21





                      ECG report 


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 

Patient was referred to ophthalmologist for visual acuity testing and fundoscopy for raised IOP 

                  Medication Chart 


                        On 29/11/21 

                  Fever chart 

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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