IATROGENIC CUSHINGS SYNDROME

 [  ] This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

[  ] This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

[  ] I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

[  ] CHIEF COMPLAINTS... 

22 years old female daily wage labourer by occupation presented to the opd with 

C/O   PAIN and SWELLING  in left limb below knee since 1 month.. 

[  ] HISTORY OF PRESENT ILLNESS......

 Patient was apparantly asymptomatic 1year ago then she developed  round skin lesions which are associated with itching so that  they went to local RMP doctor and used some topical ointment for period of 3-4 months  but patient did not get any relief .So they again went to RMP then patient was prescribed with AVIL (anti allergic )and DECADRAN (dexamethasone )  injections and patient used them for a period of 3-4 months even then patient did not got relieved from her skin lesions and then she came to our hospital and here she was given ITRACONAZOLE  later her skin lesions got subsided . 3 months ago  she had developed  fever then she underwent some investigations and was found to be diabetic and was on medication TAB.METFORMIN 500MG  OD and on INJ. MIXTARD S/C 6U

H/o facial puffiness since 3 months .

Decreased urine output since 1 month .

  H/o pain in the left lower limb since 1 month denies history of trauma later on swelling appeared which got burst with pus discharge and  underwent aseptic dressing for 1 week  and later it got progressed and patient is unable to walk due to pain .

H/o fever since 1-2 weeks on and off subsiding on taking medication , it is associated with nausea .

No h/o vomiting ,loose stools . 









[  ] PAST HISTORY...... 

Known case of  DM since 3 months on tab metformin 500mg and inj. Mixtard 6u ---x---x 

Not a known case of HTN, Asthma, Epilepsy , TB, CAD. 

 Underwent LSCS due to delayed labour. 

[  ] PERSONAL HISTORY..... 

DIET :Mixed  

Appetite : decreased 

Bowels : c/o Constipation 

Micturition : Decreased urine output . 

No known allergies  

No addictions. 

[  ] FAMILY HISTORY..... 

No significant family history . 

[  ] MENSTRUAL AND OBSTETRIC HISTORY...

Menarche -13 years

6/30cycle

P1L1   LSCS.

[  ] GENERAL EXAMINATION.... 

Patient is conscious , coherant, cooperative.

Moderately built and moderately nourished .Well oriented with time ,place and person  .NO  pallor ,icterus ,cyanosis ,clubbing ,lymphadenopathy 

Unilateral left lower limb edema  which is of pitting type . 

Vitals : 

Temp: 98.6  

BP- 100/70 mmhg 

PR- 92/min 

RR- 18/ min  

Spo2- 98% 

Grbs- 372mg% 

[  ] SYSTEMIC EXAMINATION..... 

RS: BAE+,NVBS+ 

CVS:S1 S2 +no murmurs. 

CNS :No focal neurological  deficits. 

PA:SOFT ,NON TENDER,BOWEL SOUNDS+ 

INVESTIGATIONS:









[  ] PROVISIONAL DIAGNOSIS... 

? Iatrogenic Cushing's with h/o tenia corporis 

K/c/o taenia corporis  

LEFT LOWER LIMB CELLULITIS WITH UNCONTROLLED DIABETES MELLITUS .

[  ] TREATMENT: 

- IVF - NS , RL @100ML/HR 

- INJ. PAN 40MG IV OD BBF 

- INJ . NEOMOL 1GM IV SOS (IF TEMP> 101) 

- INJ.HAI S/C TID  

- TAB. DOLO 650MG PO SOS  

- SYP . POTCHLOR 10 ML PO IN 1 GLASS OF WATER TID.





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