Thankyou Govardhini for making the case report
https://srigovardhini.blogspot.com/2023/11/55m-with-dm2-jaundiceleprosy.html?m=1
IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT.
This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.
I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan
Chief complaints:-
Fever since 15 days
Yellowish discoloration of eyes and skin since 15 days
The male resident of Nagarjuna Sagar, born and raised in the same town, attended school until the 3rd standard but discontinued due to a lack of interest in studies. He started working at a young age, assisting his parents in caring for his siblings and taking on responsibilities as the elder son, contributing to the family even after discontinuing his education.
The entire town, where all residents are relatives, used to celebrate Dasara grandly. However, this festive tradition was interrupted when the patient was hospitalized, creating a somber atmosphere for his family and cousins.
Twenty years ago, the patient earned a living by selling alcohol produced at home by his wife. Concurrently, he developed a drinking habit. With the income generated from alcohol sales, he invested in green fields and transitioned to farming, a venture he has been involved in for the past 10 years.
A year ago, he noticed a painless, non-itching hypopigmented lesion on his left wrist. Despite being diagnosed with leprosy and recommended treatment by a doctor, he initially neglected it as the lesion caused no discomfort. Over time, as the lesion expanded, he sought medical attention again and commenced Dapsone treatment. Two weeks into the treatment, he experienced fever and yellowish discoloration of the eyes.
Fifteen days ago, he developed insidious, low-grade fever with associated chills and rigors, lasting a week and relieved with medication. Subsequently, he observed yellowish discoloration of urine and eyes.
He reported a one-day history of non-productive, dry cough. No associated symptoms like sore throat, palpitations, shortness of breath, decreased urine output, chest pain, hematuria, bleeding gums, rectal bleeding, loose stools, vomiting, or abdominal pain were reported. Two days ago, the patient noted pedal edema of the pitting type, coinciding with a sedentary period of five days.
CLINICAL IMAGES:-
Past history in brief:-
K/c/o Diabetis mellitus II since 6 years, on unknown medication
N/k/c/o HTN, BA ,CVA , CAD , TB, Epilepsy
H/O Leprosy ? Hypopigmented patches 1year ago.
PERSONAL HISTORY
Married
Mixed diet
Decreased Appetite
Regular Bowel and bladder
No allergies
Alcoholic since 20 years, stopped one year ago.
FAMILY HISTORY
Not significant
GENERAL EXAMINATION:
Patient is conscious, coherent and co-operative,well oriented to time,place and person.
Moderately build and well nourished.
Examination was done in a well lit room.
Pedal edema + ( grade 2)
Icterus +
No pallor, cyanosis,clubbing,lymphadenopathy
Vitals
PR- 96 bpm
BP- 130/80 mm Hg
RR- 16 cpm
Temp -100 F
GRBS - 144 mg/dl
No organomegaly
INVESTIGATIONS
31/10/23
PROVISIONAL DIAGNOSIS
? Drug induced hepatitis
K/c/o Leprosy
K/c/o DM II
Dapsone syndrome?
With anaemia
TREATMENT
INJ.PIPTAZ 2.25 iv/ TID
INJ. Lactulose 10 mg PO/BD
T. Rifixime 200 mg PO BD
INJ. VIT K 10 mg iv/OD
T. Dolo 650 mg PO/TID
Analysis
1. **Socio-Cultural Impact on Health:**
- The patient’s upbringing in a close-knit community with strong familial ties influenced his sense of responsibility and decision-making, particularly in prioritizing work over education.
2. **Economic Transition and Health Habits:**
- Transitioning from selling alcohol to farming reflects significant life changes, including the development of a drinking habit which likely contributed to long-term health issues.
3. **Delayed Medical Attention:**
- The patient's initial neglect of a painless hypopigmented lesion on his wrist, despite a leprosy diagnosis, underscores the common issue of delayed medical attention due to lack of symptoms or discomfort.
4. **Complications from Treatment:**
- The onset of fever and jaundice shortly after starting Dapsone treatment for leprosy indicates possible drug-induced hepatitis, demonstrating the need for careful monitoring of medication side effects.
5. **Symptom Progression and Chronic Illness:**
- The progression of symptoms from a lesion to systemic issues such as fever, jaundice, and pedal edema suggests the potential for underlying chronic conditions or complications from untreated infections.
6. **Community and Emotional Health:**
- The impact of the patient’s hospitalization on community celebrations highlights how individual health issues can affect the emotional well-being of the entire community.
**Outcome:**
The patient’s complex health journey reflects the interplay of socio-economic factors, lifestyle choices, and delayed healthcare intervention. His case underscores the importance of early diagnosis, adherence to treatment, and the management of chronic conditions to prevent complications and improve overall health outcomes.
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