My patient is a 66year old male, shepherd by occupation referred from dermatology dept.
Patient c/o blisters all over the body and a swelling of the distal part of left middle finger.
H/O itching all over the body since 5 years.
HISTORY OF PRESENT ILLNESS
Patient was apparently asymptomatic 5years back,then he developed itching all over the body which was on and off.Five days back, patient developed multiple polysized, painful blisters on both legs&hands,buttock and on the chest,associated with crusting,oozing and bleeding.There is a swelling at the distal phalanx of the left middle finger which is associated with a blister,the swelling is filled with serosanguinous fluid and is resolved after incision and drainage.
PAST HISTORY
No h/o similar blisters in the past.
Patient is a k/c/o diabetes and hypertension since 5 years.
No h/o asthma,epilepsy,TB,CAD.
DRUG HISTORY
Telmisartan for hypertension
Metformin 500mg for DM
PERSONAL HISTORY
Diet- mixed
Appetite- normal
Sleep- adequate
Bowel and bladder- regular
Addictions- alcohol occasionally
Allergy -allergic to brinjal and potato.
GENERAL EXAMINATION-
Patient is conscious, coherent and cooperative
Moderately built and nourished
Pallor - absent
Icterus- absent
Cyanosis- absent
Clubbing- absent
Lymphadenopathy- absent
Edema- absent
VITALS -
Temperature- afebrile
Pulse rate - 76 bpm
Respiratory rate - 18 cpm
BP - 120/80 mm of hg
SYSTEMIC EXAMINATION-
1.Cardiovascular system
S1 ,S2 heard
No murmurs.
2.Respiratory system
Position of trachea-Central
Breath sounds-vesicular
Bilateral air entry is present
Multiple blisters are present over the chest and back,which are associated with bleeding and crusting.
3.ABDOMEN
Soft,palpable and non tender
No organomegaly
4.CNS
Patient is conscious
Speech normal
No signs of meningeal irritating
Motor and sensory system- Normal
Reflexes - present
Cranial nerves - intact.
PROVISIONAL DIAGNOSIS
?Bullous pemphigoid
INVESTIGATIONS
-Culture and sensitivity of the pustule
TREATMENT
CAP.AMOXICLAV 625mg B/D
FUSIDIC CREAM B/D
TAB.ATARAX 10mg O/D
TAB.DOLO 650mg B/D 3 DAYS
INJ HAI SC/TID premeal
Strict diabetic diet
GRBS monitoring
D/D
Bullous impetigo
Folliculitis with acute paronychia
Eczema associated with 2° bacterial infection.
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