29 year old female with c/o joint pains since 10 months

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January 9,2022.

Name:R.Navya

Roll No:112

9th semester

29 YEARS OLD FEMALE WITH C/O JOINT PAINS and ITCHY SKIN LESIONS SINCE 10 MONTHS

29 year old female came to the op with

*Chief complaints of:-

•Bilateral joint pains in upper and lower limbs(knees, hip, ankle, shoulder, elbow, wrist, including small joints) since 10 months.

•Itchy lesions over the face,upper aspect of the chest, neck and back of the neck and upper trunk with dark coloured lesions over the knuckles since 10 months.

•Generalised weakness since 10 months - Inability to comb the hair, difficulty in walking and inability to sit down.

*History Of present illness:-

•Patient was apparently asymptomatic 10 months ago after which she developed bilateral symmetrical multiple joint pains involving small joints and it's severe in the knees which was insidious in onset, gradually progressive, aggravated on walking and relieved on medication i.e.tab.HYDROXYCHLOROQUINE 200 mg

Associated with morning stiffness.

•Around the same time she developed itching over neck and upper chest area.The area was initially red and turned black due to itching.

•H/o Dark coloured skin lesions over the knuckles since 10 months

•H/o photosensitivity present (Itching increases on sun exposure)

•H/o Alopecia since 10 months. It was gradually progressive leading to severe hair loss over the past 10 months. Associated with thinning of hair.

•H/o bilateral pitting type of pedal Edema and Edema over the dorsal aspect of hands.

•H/o generalised weakness since 10 months.

•H/o Dfficulty in walking and difficulty to sit down.

•H/o distal muscle weakness manifested in the form of : difficulty in mixing food, eating with hands, dressing and undressing, combing of hair.

•H/o proximal muscle weakness manifested in the form of : difficulty in getting up from squatting position, getting objects present at a height.

•H/o weight loss of 4-5 kgs over the last 10 months.

•H/o Oral ulcers on and off since 10 months.

•H/o vaginal discharge since 7-8 months. It was initially curdy white discharge which later changed to watery discharge. Associated with itching.

•H/o Genital ulcers on and off since 7 months.

•Dyspnea on exertion (NYHA- 3),gradually progressive since 4-5 months.

•No h/o fever, cold, cough.

*Past History:-

•No similar complaints in the past.

•Not a k/c/o DM, HTN,TB, epilepsy, Asthma, CVA, CAD.

*Menstrual History:-

•Age of menarche:-11 years

•Duration of cycle :- 3/28 days

•Regular cycle with no pains and no clots.

*Marital History:-

•Age at marriage:19years

•Non consanguinous marriage

•Primary infertility (Nulligravida)

*Personal History:-

•Diet- Mixed

•Appetite- Decreased

•Sleep- Inadequate since 10 months

•Bowel and bladder habits- Regular

•No addictions

•No known drug allergies

*Family History

•Not significant

*General Examination:-

•Patient is conscious, coherent and cooperative.Well Oriented to time, place and person.

•She is moderately built and moderately nourished.

•Pallor- Present

•Icterus-Absent

•cyanosis-Absent

•clubbing-Absent

•lymphadenopathy-Absent

•Pedal Edema- Present

*On Examination:-

Diffuse mottled erythematous hyperpigmentation (Heliotrope rash) noted on B/L cheeks, nose(bridge) involving nasolabial folds, ears, neck extending onto upper chest and back forming a ‘V’ on anterior chest (Shawl sign) and (V sign).
Single erythematous macule noted over the right loin (Holseir sign).
Pigmentation of B/L extensor surfaces of PIP and DIP noted (Gottron's papules).

•Mottled erythematous lesions on the palms