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WEL COME TO. SEMINAR ON. BULLOUS DISEASES OF SKIN. CASE HISTORY. NAME : MARJINA BEGUM  Age : About 25 year  Sex : Female  Marital Status: Married  Occupation : House wife.

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WEL COME TO

SEMINAR ON

BULLOUS DISEASES OF SKIN


Case history

CASE HISTORY

NAME : MARJINA BEGUM

 Age : About 25 year

 Sex : Female

 Marital Status: Married

 Occupation : House wife.


Address : Vill : Kujghar, Post : Kujghar,P.S.: Sadar, Dist : Jamalpur. Date of Admission: 08-11-2005 Date of Examination: 09-11-2005


Chief complaints
CHIEF COMPLAINTS

 Diffuse painful blisters & crusted lesions over scalp, face, trunk, upper extrimities & groin.For about 1½ month. A few small blisters in mouth cavity For 7 days.


H o present illness
H/O PRESENT ILLNESS

The patient states that she was all right about six months back. Then she developed a few blisters with itching at lower part of back of Lt painful blisters


side. Subsequently after 4 months she developed various sizedassociated with itching at her chest, back, upper extrimities, scalp, face, groin & a few painful lesions is oral mucous membrane which became crusted,


With above complaints she was admitted in Mymensingh Medical College Hospital for proper management. exfoliative, reddened with moist surface


H o past illness
H/O PAST ILLNESS Medical College Hospital for proper management. exfoliative, reddened with moist surface .

Nothing contributory.

  • Personal History: Married for 4 years.

    No issue.

    Menstruation : Regular.

    Habitchewing of battle

    nut +


Medical College Hospital for proper management. exfoliative, reddened with moist surface Family History: No any of her

family members

suffered from any

such notable disease.


Medical College Hospital for proper management. exfoliative, reddened with moist surface Treatment History: Patient was admitted with complaint mentioned in MMCH on 20-10-2005 & was treated with long acting steroid triamcinolone acetonide parenterally & was improved.


General examination
GENERAL EXAMINATION. Medical College Hospital for proper management. exfoliative, reddened with moist surface

 Appearance : Ill looking.

 Body build : Average.

 Anaemia

 Jaundice Absent.

 Cyanosis


Medical College Hospital for proper management. exfoliative, reddened with moist surface Oedema

 Dehydration

 Clubbing

 Koilonychia

 Hair

 Nail

Absent

Absent

Normal


Medical College Hospital for proper management. exfoliative, reddened with moist surface Pulse : 86/min/reg/mod.

 B.P : 120/35mm of Hg.

 Temp : Normal

 Respiration : 14/min.

 Neck veins : Not engorged.

 Lymph Node : Not palpable.


Examination of integumentary system
EXAMINATION OF INTEGUMENTARY SYSTEM. Medical College Hospital for proper management. exfoliative, reddened with moist surface

 Inspection Vesicles & bulla on

scalp, face, chest, back, upper extrimities, groin, some on normal skin & some are erythomatous based.


Crust & erosions with scaling in some areas & superfical ulceration in oral cavity.


superfical ulceration in oral cavity. Palpation : Vesicles & bullae are flacid, tenderness present

NIKOLSKY Sign - Present.Bulla – spread plenomenon (The Asboe- Hansen sign) – Present.


Examination of other system
EXAMINATION OF OTHER SYSTEM superfical ulceration in oral cavity. :

NAD except a few oral mucosal

lesions.


Salient features
SALIENT FEATURES. superfical ulceration in oral cavity.

Marjina Begum, Age about 25 years of vill Kujghar, Jamalpur was admitted in MMCH on 08-11-05 with complaints of progressive development of painful blisters. Crust, erosions & exfoliative lesions associated with itching


over scalp, face, trunk, upper arms, groin & a few small painful blisters in oral cavity. Examination shows flaccid & vesicles, Bullae, crusted & exfoliative lesions with erythomatous base at the mentioned sites. The lesions are


tender, moist with malodourous condition & a few superficial erosions in oral mucous membrane.

Nikolsky sign – Present

Bulla – Spread Phenomenon – Present.


Provisional diagnosis
PROVISIONAL DIAGNOSIS. erosions in oral mucous membrane.

 Pemphigus foliaceous.

D/D. : Pemphigus Vulguris.

Pemphigus vegetans.

Bullous Pemphigoid.

SSSS

Cicatrical Pemphigoid.

Stevens johnson syndorme & TEN.


Investigation
INVESTIGATION. erosions in oral mucous membrane.

 Skin biopsy for Histopathology & IF test.

 Blood for TC DC Hb% ESR - 6600/cmm. N-62%, L-32%,

M-02%, E-0%, Hb%- 80%,ESR- 10mm/1st hour.


erosions in oral mucous membrane. Random blood suger.- 103mg/100 ml.

 Urine for R/E. - NAD

 Blood Urea. - 18mg/100ml.

 Serum creatinine. - 1.0mg/100ml.


BIOPSY FOR HISTOPATHOLOGY : erosions in oral mucous membrane.

 Finding : Pemphigus compatible with pemphigus foliaceous.

CONFIRMATORY DIAGNOSIS.

 Pemphigus foliaceous.


Treatment
TREATMENT. erosions in oral mucous membrane.

 Inj. - TRIAMCINOLONE ACETONID 1AMP I/M stat and 1amp on 3rd day & 1 amp on 7th day.

 Tab. - Prednisolon -80mg/day.

 Tab. - Neotack (150mg) 1+0+1 daily.


Treatment contd
TREATMENT(Contd). erosions in oral mucous membrane.

 Cap. - Sefradine (500mg)1+1+1+1 daily.

 Tab. - Alatrol 0+0+1 daily.

 Potash wash - daily.1% Silver sulphadiazine ointment -

daily.


Salient feature
SALIENT FEATURE. erosions in oral mucous membrane.

Mr. Sumon Das, son of Dr. Kanu Das, aged 29 years hailing form Jamalpur was admitted in MMCH, Cabin-7 on 28th November,2005. He was referred to skin & VD OPD on 30th Nov. 05 with the complaints of exfoliation of


skin with generalized mild itching for 20 days, a known case of hypothyroidism due to thyroidectomy 3 months back & bronchial asthma from childhood. On examination we found extensive scaling all over the skin with erythema


and itching, mild leg oedema & puffy face. Pt’s pulse was 96/min, BP= 120/65 mm of Hg, temp. = 101.40F, lungs, heart & urinary output – normal. There was no mucous membrane and nail changes. Pt. also complaints of


chilling & gave H/O taking tab. Ibuprofen 20 days back and also paracetamol & azithromycin. With these above features our diagnosis is drug induced exfoliative dermatitis.


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