AUTOIMMUNE CASE

Hello everyone.. I am Sai Teja, an intern posted in medicine department and one of the important terms of getting the internship completion is to complete my log book with my online log of what I learn during the course of my duties.

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 also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome.

Here is a case i have seen

A 40 year old female resident of khammam who is a known hypertensive since 3 months came to opd with c/o bilateral swelling of lower limbs since 6 months, Shortness of breath since 6 months,joint pains since 4 months, and facial puffiness since one week, decreased urine output since 2 days

Patient was apparently asymptomatic 2 years back.She had h/o amenorrhea for which she went to local hospital and diagnosed to have anaemia and used medication for one month and was able to do routine work without any limitation.Then in Dec 2019, she went to a hospital with c/o swelling of both upper limbs upto wrists along with pain.The swelling was pitting type and then the swelling subsided with oral medication.Then in Jan 2020 the patient again went to a hospital with c/o swelling of both lower limbs which then gradually progressed to thighs which was pitting type and she had difficulty in standing and squating due to pain she was told she has some kidney issue and after three days there was abdominal distension also associated with fever loss of appetite and myalgias.Then she used Wysolone 10mg(Prednisolone) for 2 weeks and the complaints subsided.In the monthTmonth of February she has multiple oral ulcers all over buccal mucosa which were painfull and she developed bilateral swelling of both lower limbs upto thigh a/w pain in the joints i.e shoulder joint,elbow joint,wrist joint,knee joint,ankle joint and she also had flexion deformity.Then she went to hospital in khammam and diagnosed with Hypertension and started with medications i.e Tab Telmisartan 40 mg, Amliodipine 5mg, Hydrochlorothiazide 12.5mg, Lasilactone.

Then in July 2020 she had a blood transfusion for anaemia.C/O low grade fever, abdominal distension, decreased appetite, loss of weight a/w hairloss since one month a/w fatigue ,c/o facial puffiness since one week.

She had a surgical history of Tubectomy 22 years back.

Menstrual History:- Age of Menarche:13 yrs

Menstrual Cycle:3/30, regular not associated with pain and clots

h/o amenorrhea since 2 years

General Examination:

On examination the patient conscious,coherent,cooperative oriented to time,place and person and moderately built and poorly nourished.Pallor is present and bilateral pedal oedema is seen.Cyanosis, lympadenopathy, clubbing of fingers, icterus are absent.