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


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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 Night
  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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