40yr/ F with facial puffiness since 1 year.

​A 40/F Came with complaints of  

1)Facial puffiness since 1 year 

2)Itching all over the body since 1 year  and developed multiple plaques on abdomen and Lower limbs.                                                             3)abdominal distention since 1 month.

4)Sob on exertion since 1 month.

5)pedal edema since 5 days pitting type.

H/O PRESENT ILLNESS

1)Patient was apparently asymptomatic 1 year back then she developed abdominal distension.           2)facial puffiness,itching all over the body                3)sob on exertion since one month.                              4)5 days ago she developed pedal edema (grade3) of both limbs.                                                         5)Decrease of urination since 10days   

6)Patient complains of pain in both the knees and pain in abdomen.

Pain -gradual in onset, progressive ,

           Agressive on sitting & squatting

           Relieved on rest.

Itching scaly lesions all over the body.

Abdominal distention:

               PAST HISTORY:

she developed b/L knee pain 2 years ago and is under medication( demisone 0.5 mg and acelogic SR). 

Not a K/C/O DM/HTN/ asthma / Ischemic heart disease .

No h/o of trauma

                Fever 

                Loss of weight

                Loss of appetite.

FAMILY HISTORY 

NO SIGNIFICANT FAMILY HISTORY

PERSONAL HISTORY:

OCCUPATION -Daily wage worker

DIET -MIXED

APPETITE -decreased 

SLEEP -NORMAL

BOWEL AND BLADDER HABITS : decreased urine output 

ADDICTIONS: NO

GENERAL EXAMINATION :

Patient is concious coherent and coperative

VITALS :

BP -110/80

PR -90bpm

TEMP 98.5degrees F

SPO2 98 @ RA

GRBS -106

General examination:

NO -PALLOR, ICTERUS , CYANOSIS, CLUBBING , LYMPHADENOPATHY 

*edema on both lower limbs-pitting type.

SYSTEMIC EXAMINATION:

CVS-S1 S2

P/A-SOFT, NON TENDER, NO ORGANOMEGALY 

RS - BAE                                                            plaques on lower limbs:

                     INVESTIGATIONS:

Lipid profile: total cholesterol:248mg/dl

                      Triglycerides:347mg/dl

                       HDL:49mg/dl

                       LDL:92mg/dl

                       VLDL:69.4mg/dl

PROVISIONAL DIAGNOSIS:

? It might be iatrogenic Cushing's syndrome associated with tinea corporis.

TREATMENT:

 Tab:ATARAX 25mg for itching

 Ointment luliconazole cream for ringwarm infection.

Injection;LASIX 40mg/IV/BD

Tab:ALDACTONE 25mg/PO/BD

Injection:PANTOP 40mg/IV/OD

Injection:OPTINEURON 1amp in 100ml in normal saline /IV/OD

Tab:ULTRACET/PO/BD

Knee caps 

Strict I/O charting