61Y MALE WITH PSORIASIS
NOTE: THIS IS AN ONLINE E LOGBOOK 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 INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.
This is the case of a 61-year-old male, resident of West Bengal, and retired Engineer by occupation. The following history was taken through a telephone conversation. The patient was explained about confidentiality and written consent was taken to create the following case report.
This case report aims to record the patient's journey.
CHIEF COMPLAINTS:-
- Patient complains spreading of rash since last forty years.History of present illness:-
According to the patient, the onset of rash was gradual and nature of the rash is progressive over the last forty years. It started off as a itchy, red lesion at the base of the penis, which gradually spread through out the body (as shown in the clinical images given below). It was painful upon touch and the pain was consistently there, however it would transfer to other parts of the body as described by the patient. The intensity of pain in the rashes would increase if the patient is exposed to the sun. The intensity of pain would be relieved (especially at the back) if the patient uses a blow drier on the lesion. The nature of pain at that time, as described by the patient, would be similar to that of burning. Another characteristic feature as reported by the patient is that if the pain decreases, then the colour of the lesion would change from red to black and the size of the lesion would also increase. Currently, the patient reports that the pain is not as intense as it used to be previously but the itchiness is still present.
The patient also reports having kidney stones of size 4mm for the past 12-13 years. According to the patient, there is no abdominal pain. However, the patient reports experiencing polyuria, micturating 3-4 times in the night. No surgical intervention nor medication has been done.
History of past illness:-
The patient has no history of TB, Asthma or Epilepsy.
The patient has a history of having DM and HTN.
10-11 years ago, the patient has undergone surgery for the removal of a tumor in the Axillary region. 2-3 years ago, the tumor has reappeared just above the same location where the tumor was earlier removed. It is painless and there has been no surgical intervention done since.
Personal history:-
Water intake:- normal (2L max.)
Appetite:-normal
Diet:- mixed
Bowel movement:- Constipation. Patient is only able to excrete once after two-three days.
bladder movement:-Polyuria
Addictions:- Consumes supari.
Alcohol:- none
Smoking:- doesn't smoke
Allergies:- none.
Exercise status:- Patient used to do pranayam in the morning for 30 minutes. For the last 2-3 months, the patient doesn't do pranayam anymore.
Family History:- Patient's mother had a rash on her left leg, just below the knee.
Clinical Pictures:
Final diagnosis :
CHRONIC PLAQUE PSORIASIS with Left INGUINAL HERNIA and hydrocele
61 year old male,civil engineer from west Bengal, came to medicine department with chief complaints of itchy skin lesions on buttocks,legs,hands,thigh since 40 years.
patient was apparantly asymptomatic 40 years ago then he developed a a itchy, red lesion at the base of the penis, which gradually spread through out the body associated with burning type of pain and itching, constant in nature aggravated on exposure to sun , relieved by blowdrier.
PAST HISTORY :
k/c/o psoriatic arthritis since 43 years ( relieved from
k/c/o chronic bronchitis since 42 years
k/c/o BPH also have kidney stones of 4mm size.
k/c/o DM and Hypertension since 4 months
PERSONAL HISTORY:
Water intake:- normal (2L max.)
Appetite:-normal
Diet:- mixed
Bowel movement:- Constipation. not able to pass stools , only passes after medication.
bladder movement:-Polyuria
Addictions:- Consumes supari.
Alcohol:- none
Smoking:- doesn't smoke, stopped smoking 30 years ago
Allergies:- none.
Exercise status:- Patient used to do pranayam in the morning for 30 minutes. For the last 2-3 months, the patient doesn't do pranayam anymore.
FAMILY HISTORY
Mother is a known case of rheumatoid arthritis.
TREATMENT HISTORY
Methotrexate 10 mg used for 13 months
Tofacitinib used for 3 months for arthritis.Etoricoxib, folinic acid also used .
Patient is on different treatments ( homeopathic,allopathic, ayurvedic ) from past few years.
Course in hospital :
DAy 1 c/s/by DERMA , asked for review after reports diagnosed as chronic PLAQUE psoriasis
patient has been managed by symptomatically.
Patient history and musculo skeletal examination done and found to be normal except for his right hip pain
DAY 2 patient was investigated further investigations sent .as his BP increasing, TELMA 20 was added
DAY 3 Patient found to have inguinal hernia along with hydrocele , surgery referral was done.
Day 4 , patients derma review referral was done , in which patient has been advised medications.
ADVICE AT DISCHARGE:
TAB ACETRETIN 25 mg OD
TAB NMFE LIP BALM
VENUSA MAX COTTON L/A BD × 2 weeks
HAWS- X L/A OD× 2WEEKZ
TAB TECZINE 10 mg OD×2 weeks
TAB PAN 40 MG po/OD
TAB TELMA 20MG PO/OD.
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