A 48 yo Male with B/L Pedal Edema, Facial Puffiness and Itching

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This is online E log book to discuss our patient’s de-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 patients clinical problems with collective current best evidence based inputs.

This is an ongoing case. This blog post will be updated regularly.


CHIEF COMPLAINTS:

 A 48y old male came to OPD with chief complaints of

  • B/L pedal edema  since 10 days , facial puffiness since 10 days 
  • Itching since 1 year

HISTORY OF PRESENT ILLNESS: 

  • Patient was apparently asymptomatic till 1 year 
  • Then he developed, itching which was gradual onset 
  • It began in the right arm ,then gradually progressed on the abdomen followed by whole body for which he went to near by RMP doctor and got injection AVIL for 1 year, 
  • H/o use of unknown drugs later was referred to one hospital and diagnosed with TINEA CORPORIS CURIS for which he was on regular medication


HISTORY OF PAST ILLNESS:

Known case of 

  • Diabetes mellitus since 1 year and on T.VILDANE-H SR medication
  • HTN since 1 year and on T.AMLONG 5mg 


PERSONAL HISTORY:

  • Marital status: married
  • Appetite: normal 
  • Diet: mixed
  • Bowel and bladder: regular
  • Addictions: alcohol consumption occasionally (90ml) since 20 years 
  • Allergies: None

FAMILY HISTORY:

Daughter was admitted for the same complaints 3 days back. 


PHYSICAL EXAMINATION:

GENERAL:

  • Patient is conscious coherent and cooperative and examine well lit room.
  • Pedal edema : ++
  • No signs of pallor, Cyanosis, clubbing, Icterus, lymphadenopathy .

VITALS:

  • Temperature: 96.5° F
  • Pulse rate: 99 BPM
  • Respiratory rate: 18 cycles per minute
  • BP: 140/80 mm of Hg
  • SpO2: 99% at room air
  • Grbs: 115mg%

SYSTEMIC EXAMINATION:

CVS:

S1, S2 heard

RESPIRATORY SYSTEM:

NVBS heard

PERABDOMEN:

  • Shape: Obese
  • Tenderness: Absent
  • No palpable mass , no organomegaly

CNS:

  • Level of consciousness – alert
  • Speech-normal
  • No signs of Meningeal 
  • Reflexes normal.


PROVISIONAL DIAGNOSIS:

IATROGENIC CUSHING'S SYNDROME 2° TO DRUG ABUSE WITH TINEA CORPORIS CURIS










INVESTIGATIONS:

1. Serum electrolytes


2. Blood urea



3. CBP


4. CUE


5. ECG


6. Blood Sugar - Random


7. Serum Creatinine


8. Glycated Hb


9. Ultrasound


TREATMENT:
16/7/21:
  1. Tab. AMLONG 5mg/PO/OD
  2. Tab. VILDANE-M-SR /PO/OD
  3. Tab. TECZINE 10mg/PO/OD @8am
  4. Tab. ATARAX 25mg/PO/HS @8pm
  5. Luliconazole Cream for L/A Twice Daily
  6. Ebernet Cream for L/A at Nights
  7. Abzorb Dusting Powder
  8. Liquid Paraffin for L/A
  9. Protein Powder 2 tbsp in 1 glass of Milk /PO/TID
  10. 2 Egg Whites/day
17/7/21:
  1. Tab. AMLONG 5mg/PO/OD
  2. Tab. VILDANE-M-SR /PO/OD
  3. Tab. TECZINE 10mg/PO/OD @8am
  4. Tab. ATARAX 25mg/PO/HS @8pm
  5. Cap. ITRACONAZOLE 200mg/PO/BD x 2wks
  6. Luliconazole Cream for L/A Twice Daily
  7. Ebernet Cream for L/A at Nights
  8. Abzorb Dusting Powder
  9. Liquid Paraffin for L/A
  10. Protein Powder 2 tbsp in 1 glass of Milk /PO/TID
  11. 2 Egg Whites/day
18/7/21:
  1. Tab. AMLONG 5mg/PO/OD
  2. Tab. VILDANE-M-SR /PO/OD
  3. Tab. TECZINE 10mg/PO/OD @8am
  4. Tab. ATARAX 25mg/PO/HS @8pm
  5. Cap. ITRACONAZOLE 200mg/PO/BD x 2wks
  6. Luliconazole Cream for L/A Twice Daily
  7. Ebernet Cream for L/A at Nights
  8. Abzorb Dusting Powder
  9. Liquid Paraffin for L/A
  10. Protein Powder 2 tbsp in 1 glass of Milk /PO/TID
  11. 2 Egg Whites/day
  12. Tab. PREDNISOLONE PO [5mg - x - 10mg]
19/7/21:
  1. Tab. AMLONG 5mg/PO/OD
  2. Tab. VILDANE-M-SR /PO/OD
  3. Tab. TECZINE 10mg/PO/OD @8am
  4. Tab. ATARAX 25mg/PO/HS @8pm
  5. Cap. ITRACONAZOLE 200mg/PO/BD x 2wks
  6. Luliconazole Cream for L/A Twice Daily
  7. Ebernet Cream for L/A at Nights
  8. Abzorb Dusting Powder
  9. Liquid Paraffin for L/A
  10. Protein Powder 2 tbsp in 1 glass of Milk /PO/TID
  11. 2 Egg Whites/day
  12. Tab. PREDNISOLONE PO [5mg - x - 10mg]
  13. Inj. AVIL-IM (4cc) BD 1wk 













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