50 year old female with Dysphagia under evaluation Anemia under evaluation ?ATT induced Steven Johnson ?Plummer Vinson AKI secondary to ?pre renal ?UTI k/c/o DM,HTN, HYPOTHYROIDISM, RHEUMATOID ARTHRITIS
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A 50yr old female came with c/o shortness of Breath (grade 2) since 20 days
C/o difficulty in swallowing solids and liquids since 3 days
Not able to open mouth since 1 day
HOPI: Pt was apparently alright 10 yrs ago and was diagnosed with HTN and is on medication.
6 years ago diagnosed with Hypothyroidism and is using Thyronorm 50mcg
Later was diagnosed with Rheumatoid arthritis but is not on any medication
3 months ago diagnosed with DM and is not in medication
2 months back pt had c/o cough with expectoration, pain in chest region. Was diagnosed as PULMONARY MILIARY TB and started ATT. After 1 month of use she started developing redness and itching all over the body, ATT induced Erythroderma, stopped ATT (1-2-22) for 20 days and again started using 20 days back
20days back after being discharged from a hospital admitted for ATT induced Erythroderma. She is having SOB (grade 2), not associated with any orthopnea/PND, pedal Edema, chest pain, or palpitations.
From 3 days she is having difficulty in swallowing solids and liquids and from 1 day not able to open her mouth because of pain and c/o reddish discolouration of the tongue.
PAST HISTORY: k/c/o DM since 3 months, (not on medication)
HTN since 10 yrs
(On medication)
K/c/o Pulmonary miliary TB on ATT using 3 tablets /day ( HRZE)
K/c/o Rheumatoid Arthritis and not on medication
K/c/o Hypothyroidism since 6 years On Thyronorm 50mcg
O/E : Pt is conscious, coherent and irritable
Pallor +
Icterus +
No cyanosis/ clubbing/ lymphadenopathy
Vitals at the time of admission:
Temperature:100F
PR: 98bpm
BP:130/80mm Hg
RR:27cpm
Spo2: 95%
GRBS:105gm%
CVS:s1s2 +
RS: BAE + , B/L crepts + (ISA, IAA)
P/A: soft, non tender , BS +
PROVISIONAL DIAGNOSIS:
Dysphagia under evaluation
Anemia under evaluation
?ATT induced Steven Johnson
?Plummer Vinson
AKI secondary to ?pre renal ?UTI
DM,HTN, HYPOTHYROIDISM, RHEUMATOID ARTHRITIS
INVESTIGATIONS:
ENT referral:
Dysphagia under evaluation
Advised X-ray neck lateral view, Rbs, fbs, plbs, cbp
Review to OPD with reports
Tx: 2% betadine gargles 3-4 times a day
Pulmonology referral:
Advised HRCT
Sputum c/s, gram fungal stain
Tx:
Stop ATT for 5 days
Repeat LFT , RFT after 3 days
Review sos with reports
Dermatology referral :
1) stop ATT and look for alternative drugs
2) MUCOPAIN GEL L/A ( 10 mins before each meal for oral cavity)
3) Betadine mouthwash
4) liquid paraffin all over the body 1__1__1 for 2 weeks
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