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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

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.


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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


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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,


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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.

Nothing contributory.

  • Personal History: Married for 4 years.

    No issue.

    Menstruation : Regular.

    Habitchewing of battle

    nut +


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Family History:No any of her

family members

suffered from any

such notable disease.


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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.

Appearance:Ill looking.

Body build :Average.

Anaemia

Jaundice Absent.

Cyanosis


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Oedema

 Dehydration

 Clubbing

Koilonychia

Hair

Nail

Absent

Absent

Normal


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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.

Inspection Vesicles & bulla on

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


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


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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 :

NAD except a few oral mucosal

lesions.


Salient features

SALIENT FEATURES.

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


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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


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

Nikolsky sign – Present

Bulla – Spread Phenomenon – Present.


Provisional diagnosis

PROVISIONAL DIAGNOSIS.

Pemphigus foliaceous.

D/D.:Pemphigus Vulguris.

Pemphigus vegetans.

Bullous Pemphigoid.

SSSS

Cicatrical Pemphigoid.

Stevens johnson syndorme & TEN.


Investigation

INVESTIGATION.

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.


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Random blood suger.-103mg/100 ml.

 Urine for R/E. - NAD

 Blood Urea. - 18mg/100ml.

 Serum creatinine. - 1.0mg/100ml.


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BIOPSY FOR HISTOPATHOLOGY :

 Finding : Pemphigus compatible with pemphigus foliaceous.

CONFIRMATORY DIAGNOSIS.

Pemphigus foliaceous.


Treatment

TREATMENT.

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).

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.

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


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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


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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


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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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