One of my favorite case. Before we start I want to mentioned that I wouldnt tell you one very important information from her past medical history because if I would it made diagnosis much more easy. I am suggesting you to read the case and figure out syndroms she had then you can ask questions you might want to know from her past. Thought in this case right answer could be find even ithout this hidden information. 47 yo woman was admitted to the hospital on the 6th day of illness with complaints on severe general weakness, fever up to 39C, muscle pain. 10 days ago she had acute raise of BP which she had already had several times before due to arterial hypertension. She took her regular pills to normalize blood pressue with positive effect but 4 days later she developed a small stuffy nose. Next day she developed fever up to 39C, moderate muscle amd joint pain, severe headache and vomited once. She took some antipyretics without effect and 3 days later developed a transient loss of consciousness, after which the patient became lethargic and very weak. Relatives called a doctor only next day and she was sent to infectious disease hospital. At day of addmission at the skin of the left shoulder, right thigh, one finger of both hands, and left foot sporadic eruptions of hemorrhagic nature of irregular shape, with a diameter of from 0.5 to 2.5, was found. Enanthema in the form of vesicles, some elements with hemorrhagic content on the mucosa of the hard and soft palate was present. During the examination the patient sluggish, oriented correctly, the criticism to condition is somewhat reduced, barely remembers the history of present illness - he confuses the dates and sequence of occurrence of complaints, long think about questions about the history of life, but answered correctly. BP 85/55, heart beat rate 104 per minute, the heart sounds clean, murmurs is not heard. Breath rate 18 per minute, without wheezing on auscultation. In the lower third of the tibia of both legs on the medial surface rough scar remaining after trophic ulcers were seen. From the anamnesis it is known that the first trophic ulcers she developed at the age of 19. Trophic ulcers were characterized by poor response to therapy, a prolonged period of healing, as well as persistent, relapsing course with almost annual exacerbations throughout the patients life. Couple of month ago trophic disorders first appeared on the rise of the right foot. From her past medical history we know that she suffers from arterial hypertension, occasionally marked acute rise in BP. CBC: WBC 7,2, HGB 115, Tr 12, ESR 47 mm/hour. Biochemistry: creatinine 568, urea 27, bilirubin 27, ALT 107, AST 248, Creatinine phosphocinae 375. What is a diagnosis and which test or procedure you want to do?
Posted on: Sat, 30 Aug 2014 10:15:32 +0000
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