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CASE HISTORYCASE HISTORY NAME NAME :: MARJINA BEGUM MARJINA BEGUM
AgeAge :: About 25 yearAbout 25 year
SexSex :: FemaleFemale
Marital Status:Marital Status: MarriedMarried
OccupationOccupation :: House wife.House wife.
Address :Address : Vill : Kujghar, Vill : Kujghar,
Post : Kujghar,P.S.: Sadar, Post : Kujghar,P.S.: Sadar,
Dist : Jamalpur.Dist : Jamalpur.
Date of Admission:Date of Admission: 08-11-200508-11-2005
Date of Examination:Date of Examination: 09-11-200509-11-2005
CHIEF COMPLAINTSCHIEF COMPLAINTS
Diffuse painful blisters & crusted Diffuse painful blisters & crusted
lesions over scalp, face, trunk, lesions over scalp, face, trunk,
upper extrimities & groin.For about upper extrimities & groin.For about
1½ month. A few small blisters in 1½ month. A few small blisters in
mouth cavity For 7 days. mouth cavity For 7 days.
H/O PRESENT ILLNESS
The patient states that she was all
right about six months back. Then
she developed a few blisters with
itching at lower part of back of Lt
painful blisters
side. Subsequently after 4 months she
developed various sizedassociated with
itching at her chest, back, upper
extrimities, scalp, face, groin & a few
painful lesions is oral mucous membrane
which became crusted,
With above complaints she was With above complaints she was
admitted in Mymensingh Medical admitted in Mymensingh Medical
College Hospital for proper College Hospital for proper
management. exfoliative, management. exfoliative,
reddened with moist surface reddened with moist surface
H/O PAST ILLNESSH/O PAST ILLNESS. .
Nothing contributory.Nothing contributory.
Personal History: Married for 4 years.Personal History: Married for 4 years.
No issue.No issue.
Menstruation : Regular.Menstruation : Regular.
HabitHabitchewing of battlechewing of battle
nut +nut +
Family History:Family History: No any of herNo any of her
family members family members
suffered from suffered from
anyany
such notable such notable
disease. disease.
Treatment History:Treatment History: Patient was Patient was
admitted with complaint mentioned in admitted with complaint mentioned in
MMCH on 20-10-2005 & was treated MMCH on 20-10-2005 & was treated
with long acting steroid triamcinolone with long acting steroid triamcinolone
acetonide parenterally & was improved. acetonide parenterally & was improved.
GENERAL GENERAL EXAMINATION.EXAMINATION. AppearanceAppearance :: Ill looking.Ill looking.
Body build Body build :: Average.Average.
AnaemiaAnaemia
JaundiceJaundice Absent. Absent.
Cyanosis Cyanosis
Oedema Oedema
DehydrationDehydration
ClubbingClubbing
Koilonychia Koilonychia
HairHair
NailNail
AbsentAbsent
AbsentAbsent
NormalNormal
PulsePulse : 86/min/reg/mod. : 86/min/reg/mod.
B.PB.P : 120/35mm of Hg. : 120/35mm of Hg.
TempTemp : : NormalNormal
Respiration : 14/min.Respiration : 14/min.
Neck veins : Not engorged.Neck veins : Not engorged.
Lymph Node : Not palpable.Lymph Node : Not palpable.
EXAMINATION OF EXAMINATION OF INTEGUMENTARY SYSTEM.INTEGUMENTARY SYSTEM.
Inspection Vesicles & bulla on
scalp, face, chest,
back, upper extrimities,
groin, some on normal
skin & some are
erythomatous based.
Crust & erosions with
scaling in
some areas &
superfical ulceration in oral
cavity.
Palpation :Palpation : Vesicles & bullae are Vesicles & bullae are
flacid, tenderness present flacid, tenderness present
NIKOLSKY Sign - NIKOLSKY Sign -
Present.Bulla – spread Present.Bulla – spread
plenomenon (The Asboe- plenomenon (The Asboe-
Hansen sign) – Present.Hansen sign) – Present.
EXAMINATION OF OTHER SYSTEM :
NAD except a few oral mucosal
lesions.
SALIENT FEATURES.SALIENT FEATURES.
Marjina Begum, Age about 25 years Marjina Begum, Age about 25 years
of vill Kujghar, Jamalpur was admitted of vill Kujghar, Jamalpur was admitted
in MMCH on 08-11-05 with complaints in MMCH on 08-11-05 with complaints
of progressive development of painful of progressive development of painful
blisters. Crust, erosions & exfoliative blisters. Crust, erosions & exfoliative
lesions associated with itching lesions associated with itching
over scalp, face, trunk, upper arms, over scalp, face, trunk, upper arms,
groin & a few small painful blisters in groin & a few small painful blisters in
oral cavity. Examination shows flaccid oral cavity. Examination shows flaccid
& vesicles, Bullae, crusted & & vesicles, Bullae, crusted &
exfoliative lesions with erythomatous exfoliative lesions with erythomatous
base at the mentioned sites. The base at the mentioned sites. The
lesions are lesions are
tender, moist with malodourous
condition & a few superficial erosions in
oral mucous membrane.
Nikolsky sign – Present
Bulla – Spread Phenomenon
– Present.
PROVISIONAL DIAGNOSIS.
Pemphigus foliaceous. D/D.: Pemphigus Vulguris.
Pemphigus vegetans.Bullous Pemphigoid.SSSSCicatrical Pemphigoid.Stevens johnson syndorme & TEN.
INVESTIGATION.INVESTIGATION.
Skin biopsy for Histopathology & IF Skin biopsy for Histopathology & IF test.test.
Blood for TC DC Hb% ESR -Blood for TC DC Hb% ESR -
6600/cmm. N-62%, L-32%,6600/cmm. N-62%, L-32%,
M-02%, E-0%, Hb%-M-02%, E-0%, Hb%-
80%,ESR-80%,ESR- 10mm/1st hour. 10mm/1st hour.
Random blood suger.-Random blood suger.- 103mg/100 ml.103mg/100 ml.
Urine for R/E.Urine for R/E. - - NAD NAD
Blood Urea.Blood Urea. - 18mg/100ml. - 18mg/100ml.
Serum creatinine.Serum creatinine. - 1.0mg/100ml. - 1.0mg/100ml.
BIOPSY FOR HISTOPATHOLOGY :BIOPSY FOR HISTOPATHOLOGY :
Finding :Finding : Pemphigus compatible Pemphigus compatible
with with pemphigus pemphigus
foliaceous. foliaceous.
CONFIRMATORY DIAGNOSIS. CONFIRMATORY DIAGNOSIS.
Pemphigus foliaceous.Pemphigus foliaceous.
TREATMENT.TREATMENT.
Inj. Inj. -- TRIAMCINOLONE TRIAMCINOLONE
ACETONID 1AMP I/M stat ACETONID 1AMP I/M stat
and 1amp on 3rd day & 1 and 1amp on 3rd day & 1
amp on 7th day.amp on 7th day.
Tab.Tab. -- Prednisolon -80mg/day.Prednisolon -80mg/day.
Tab.Tab. -- Neotack (150mg) 1+0+1 Neotack (150mg) 1+0+1
daily.daily.
TREATMENT(Contd).TREATMENT(Contd).
Cap.Cap. -- Sefradine Sefradine
(500mg)1+1+1+1 (500mg)1+1+1+1 daily.daily.
Tab.Tab. -- Alatrol 0+0+1 daily.Alatrol 0+0+1 daily.
Potash wash - daily.1% Silver Potash wash - daily.1% Silver
sulphadiazine ointment -sulphadiazine ointment -
daily.daily.
SALIENT FEATURE.
Mr. Sumon Das, son of Dr. Kanu Das,
aged 29 years hailing form Jamalpur
was admitted in MMCH, Cabin-7 on
28th November,2005. He was referred
to skin & VD OPD on 30th Nov. 05
with the complaints of exfoliation of
skin with generalized mild itching skin with generalized mild itching
for 20 days, a known case of for 20 days, a known case of
hypothyroidism due to hypothyroidism due to
thyroidectomy 3 months back & thyroidectomy 3 months back &
bronchial asthma from childhood. bronchial asthma from childhood.
On examination we found On examination we found
extensive scaling all over the skin extensive scaling all over the skin
with erythemawith erythema
and itching, mild leg oedema & and itching, mild leg oedema &
puffy face. Pt’s pulse was 96/min, puffy face. Pt’s pulse was 96/min,
BP= 120/65 mm of Hg, temp. = BP= 120/65 mm of Hg, temp. =
101.40F, lungs, heart & urinary 101.40F, lungs, heart & urinary
output – normal. There was no output – normal. There was no
mucous membrane and nail mucous membrane and nail
changes. Pt. also complaints of changes. Pt. also complaints of
chilling & gave H/O taking tab.
Ibuprofen 20 days back and also
paracetamol & azithromycin. With
these above features our diagnosis is
drug induced exfoliative dermatitis.