A 25 YEAR OLD MALE WITH GENERALIZED LYMPHADENOPATHY

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       THIS IS AN 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 A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT

                      CASE REPORT:-

A 25 year old male patient who is driver by occupation came with the 

CHIEF COMPLAINTS:- 


Pain and Redspots on the tips, pulp and nailbed of fingers (Rt hand) since 4 days in 2 fingers prominently 


HISTORY OF PRESENT ILLNESS:-

The patient was apparently asymptomatic
 4 years back then he developed  dry cough for 12 days which did not subsided on taking medication and all regular investigations are done which found that he had proteinuria and sputum test was done and it was found to be negative and he lossed weight of 6 kgs (51-45) and from 4 years he is 45 kgs.

Then one and a half month back then he had burning sensation in the epigastric region aggravated on having heavy and spicy food.

Associated with bloating after intake of food and abdominal tightness.

For which he got treated by a local doctor ( Pantop-D for 6 days)and his symptoms got relieved on taking medication and had similar complaints when he stopped medication . 

Then 4 days back he had dragging type of pain which was sudden in onset and aggravated on doing work and relieved on rest. 
No H/o trauma.

There are Redspots on the tips,pulp,nailbed of fingers of Right UL.


PAST HISTORY:-

N/k/c/o DM, HTN, TB, Asthma, Epilepsy
History of taking Rabeprozole, paracetamol, Amoxicillin, ofloxacin,multi vitamin . 

PERSONAL HISTORY:-

Appetite - Reduced

Diet- Mixed

Bowel and Bladder-Regular

Sleep- Adequate

Addictions - Nil

(Paan occasionally)

FAMILY HISTORY:-

- No Significant family history 

ALLERGIC HISTORY:-

No allergies to any kind of food and any medication . 

GENERAL EXAMINATION:-



Patient is conscious and coherent and co operative 

Thin built and well nourished.

Vitals

Temp- Afebrile 

PR- 95 bpm

RR- 16 

BP- 100/80 mm Hg

Generalised Lymphaedenopathy + (Enlarged and palpable cervical, axillary, Inguinal LN)







No pallor,
NO icterus, 
NO Cyanosis, 
No clubbing, 
No b/l pedal edema.

Systemic Examination:


CVS-

S1, S2 heard,no murmurs

Respiratory System:-


Petechiae over chest.

 BAE- present 

NVBS- heard

PER ABDOMEN:-


 soft , non tender.

Liver- Palpable (Hepatomegaly)

Spleen- Palpable (Splenomegaly)

CNS- 

The patient is conscious. 

No focal deformities. 

Signs of meningeal irritation:- 

NEGATIVE



cranial nerves - intact 

sensory system - intact

motor system - intact

INVESTIGATIONS:-









DIAGNOSIS:-

Hypereosinophilia??? ( Idiopathic)

Purpura under evaluation??? 



TREATMENT:-



Points to be discussed:-

Criteria for hypereosinophilic syndrome??? 
      
             

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