A 66 year old male patient with multiple painful blisters over the body

Patient is referred from Dermatology department. 

A 66 year old male patient from Kakkereni, AP Lingotam, Shepherd by occupation came to the OPD with

C/o Multiple painful blisters all ove the body sparing palms and soles. 

History of presenting illness

Patient was apparently asymptomatic 5 years ago then he started developing itching all over the body suddenly which subsides temporarily on applying Vaseline. 

5 days ago he developed a blister on the dorsal surface of the middle distal phalynx of his left hand following which his body started itching and blisters started appearing on his body starting from the periphery spreading to the trunk which were painful. It was associated with fever but cured immediately on taking medication. The blisters are rupturing spontaneously and serosanguinous fluid is oozing out of the ruptured blister. 

Past history

He had no similar complaints in the past. 

K/c/o Diabetes mellitus since 5 years and Hypertension since 3 years and is on medication with Telmesartan and Metformin respectively. 

Not a k/c/o Tuberculosis, Asthma, Epilepsy, CAD. 

Has a history of allergy to few vegetables like Egg plant, potato. 

Personal history

Diet - Mixed

Appetite - Normal

Sleep - Inadequate due to painful blisters

Bowel and bladder movements - Regular

Addictions - Occasional Alcoholic

Family history - No other family members have similar complaints. 

Drug history - Metformin for Diabetes since 5 years and Telmesartan for Hypertension since 3 years. 


General physical examination

Patient is conscious, coherent and cooperative

Moderately built and moderately nourished

No Pallor, Icterus, Cyanosis, Clubbing, Generalised lymphadenopathy, Pedal edema

Vitals

Temperature - Afebrile

Pulse rare - 76 bpm

Respiratory rate - 18 cpm

Blood pressure - 120/80 bpm

Skin - Multiple bullae and pustules over B/L upper and lower limbs, trunk, buttocks and one on distal phalynx with erosions, crusting and oozing blood and serous fluid. 






Systemic examination

CVS - S1, S2 heard

Respiratory system - BAE present

Abdomen - Soft, Non tender

CNS - No focal neurological deficits. 


Provisional diagnosis 

Bullous Pemphigoid? 


Investigations

Culture and sensitivity of pustule

CBP, FBS, CUE, PLBS, LFT, RFT. 





ECG


USG



Treatment

Cap. AMOXICILLIN 625mg BD

FUDIC CREAM BD

Tab. ATARAX 10mg OD

Tab. DOLO 650mg BD 3x days

Inj. HAI premeal SC/TID 

GRBS monitoring

Strict Diabetes control


Differential diagnosis

Bullous Pemphigoid

Bullous Impetigo

Folliculitis + Acute Paronychia

Eczema  with secondary bacterial infection



Comments

Post a Comment

Popular posts from this blog

A 28 year old male with Gross Ascites

Image
 This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. 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 problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. A 28 year came to OPD with C/o Abdominal distention since 10 days        Abdominal discomfort since 10 days History of Presenting illness  Patient was apparently asymptomatic 10 days ago then he developed Abdominal discomfort and distention of abdomen for which he visited a primary health care centre near his residence where he was adviced to get an Xray of Abdomen for which he visited our Institution. Abdominal distention was insidious in onset and gradually progressed to current size  Patient
Read more

60 year old male with trunkal obesity with URTI, HFMEF, DM, HTN

Image
A 60 year old male came to casuality with C/o Cough, cold since 3 days         Chest pain since 1 day         Fever since 1 day HOPI Patient was apparently asymptomatic 3 days ago then he developed cough with sputum, scanty in quantity, green in color associated with cold and nasal blockage H/o Fever, low grade, continuous non aggravating and no relieving factors No h/o rash, retroorbital pain, arthralgia C/o chest pain, diffuse, squeezing type associated and aggrevating with cough, non relieving  No h/o abdominal pain, vomiting, diarrhea  No h/o seizures, tremors Past history : K/c/o DM, HTN since 10 years and on unkown medication  N/k/c/o Asthma, CAD, CVA, Thyroid disorders, Epilepsy General examination  Pt is C/C/C No Pallor, Icterus, Cyanosis, Lymphadenopathy, Edema Vitals Temperature - 100.8°F PR - 104 bpm BP - 110/70 mmHg RR - 22 cpm SpO2 - 93 @ 4L O2 GRBS - 301 mg% Systemic Examination CVS - S1,S2 heard RS - BAE present  CNS - NFND P/A - Soft, Non tender Investigations on admiss
Read more

39 year old male patient with Altered sensorium and Paraplegia

Image
A 39 year old male patient resident of Nalgonda, electrician by occupation was presented to the casualty on 9th of November,2021 As informed by his attenders C/o decreased responsiveness, loss of appetite and decreased speech since 2 days before admission and completely couldn't talk on the day of admission.  History of presenting illness   Patient was apparently asymptomatic 8months ago then he developed pain abdomen and intermittent low back pain and dribbling of urine so he visited a physician and was told to have renal stones and meatal stenosis for which he underwent urethral dilatation in July, 2021.  He was incidentally detected to have serum creatinine 5g/dL while visiting a hospital in Nalgonda. His urine output was good and he had no pedal edema or sob. He was told to have renal failure and was on medication since then. He had h/o weight loss and loss of appetite and low grade fever.  He was having intermittent back pain since then After 2 months, in the last week of Aug
Read more