40 Akshara kruthi , 5th sem


This elog depicts the patient -centered approach to learning . This is an online E log book recorded to discuss and comprehend our patients de-identified health data shared , after taking his /her /guardians signed informed consent . This elog also reflects patients centered learning portfolio.

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

August 02, 2022

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


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















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