43/F exfoliating dermatitis since 3 months

 29/09/2023

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Khushi Tulsyan, Intern

Roll no. 49

Location - ICU Bed 2

DOA - 27/09/2023

Pt presented with c/o itchy skin lesions all over the body since 3 months

Pt was apparently asymptomatic normal 3 months ago later developed itchy skin lesions all over the body

H/o fever since 3 days low grade intermittent relieved with medication 

H/o unknown inj taken 3 months back

H/o facial puffiness since 2 months

H/o Omnacortel 10 mg tab taken for 1 month

And b/l pedal edema since 3 days pitting type 

C/o of stool stools (8 episodes watery non blood stained non mucopurulent) 

Past History-

No h/o similar complaints in past 

No known co morbidities

H/o usage of Etodolac macbestin 500

ENT referal was done i/v/o rt ear pain associated with headache and diagnosed as right otitis externa 

O/E-

Pt is c/c/c 

No pallor cyanosis icterus clubbing lymphadenopathy 

Fever - 99.3F

Bp - 100/70 mmhg

Pr - 120 bpm

Rr- 21cpm

Spo2-99RA

CVS - S1 S2 +

RS - NVBS

CNS - NFND

PA - soft and nt

Skin - 

Multiple erthyematous plaques with scaling noted over chest abdomen b/l forearm arms leg cheeks forehead scalp oral cavity (caries present)

Nails no pitting

Provisional Diagnosis-

Exfoliating Dermatitis 2 to ?drug abuse 

Pyrexia under evaluation with rt otitis externa

INVESTIGATIONS-

ECG - 

C/s-

Skin scarpings KOH Mount-

No fungal elements seen

ESR - 5mm/1st hr

CRP - #1.2 mg/dl (positive)

T3 - 0.84

T4 - 7.54

TSH - 2.91

RBS - 141 mg/dl

TB - 0.60mg/dl

DB - 0.18 mg/dl

AST - 17 IU/l

ALT - 31IU/l

ALP - #196 IU/L

TP - # 5.4 gm/dl

Alb - #3.0

A/G ratio - 1.31

Blood urea - 14 mg/dl

Ser creat - 0.9 mg/dl

Uric Acud - 4.4 mg%

Na - 136

K - #3.3

Cl - 99

Ca - 1.02

Hb - # 11.0

Tlc - #12300

N/l/e/m/b - 66/#15/#10/9/0

Cue - alb and sugars nil

S ca - 8.6mg/dl