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Short case ..

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by

khitam abdullah

on 19 April 2016

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Transcript of Short case ..

Short case ..
History of present illness :
The patient was in his usual status until 4 days back when he presented to our ER complaining of fever, generalized body ache with joints pain more involving the upper and lower extremities (small joints of hands , wrists , elbow , knees) symmetrical and bilateral.

Also he has a productive cough of purulent sputum , vomiting of food content with decrease oral intake and low appetite, watery diarrhea 7-10 times /day (no mucus or blood) , associated with mild abdominal pain .

There was no history of :

-Chest pain or palpitation
-Urinary symptom. (dysuria or hematuria)
-Change in the level of consciousness .
-Contact with sick patient.
-Recent travel .
-Eating from outside or similar presentation in his family.

Mohammad is a 20-year-old male, presented to the ER with 4 days history of :

Fever
Diarrhea and Vomiting
Joints pain



Summery :
A 20-year-old male, presented to the ER with 4 days history of fever, generalized body ache with joints pain, productive cough of purulent sputum , vomiting and watery diarrhea .




Past Medical History:
Recurrent hospital admission due to same presentation .
Last admission was on OCT-2015

Family history :
Unremarkable and he has 2 sisters who are healthy.

Social history :
He lives in Tabuk with his family .
Single , student , smoker around 10 cigarette / day for 2 years.



PHYSICAL EXAMINATION



weight
85.7 kg,
Height
168

pulse
132 ,
BP
110/58,
RR
28,
temp
38.3C.

He was febrile ,dehydrated ,conscious and alert.


Chest :
decrease breath sound in RT side with inspiratory crackles
CVS :
S1 ,S2 +0
Abdomen :
mild tenderness all over the abdomen, soft , lax ,no organomegaly .
MSK:
No signs of arthritis (hotness , redness , tenderness ) or tenosynovitis of hands , wirsts , knees with full range of movements.
Multiple scaly plaque over both upper and lower extremities .
CNS:
grossly intact.

There was no lymphadenopathy.

Investigation
He is a 20-year-old male, a known case of :

-Familial Mediterranean fever (FMF)on colchicine 0.6 mg BID
-Psoriatic arthritis, on Etanercept 50 mg weekly.
-GH deficiency, on Somatotropin 6 U subcutaneous OD.

He is not compliance to his medication for the last 2 weeks

Impression
-FMF flare-up most likely 2ry to non compliance of medication.
-GE.
Plan
-IVF
-Septic screen (blood , urine , respiratory cultures , H1N1,MERS-COV , stool culture , ova and parasite)
-Methylprednisolone .
-Ceftrixone which was started by primary team
-Hold enbrel .
-Admit under Rheumatology.
Dr.Moayed Al-Khalifah (SR)
Dr.Khitam Al-Odhaibi (JR)
Full transcript