50 year female with generalized weakness

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 patients' clinical problems with collective current best evidence-based inputs.


PRESENTATING COMPLAINTS:
C/O Generalized weakness since 7 months.

HOPI:
A 50 year female presented to the OPD with complaints of generalized weakness since 7 months. History of low grade Intermittent Fever associated with chills, with evening rise in temperature, relieved on taking medication. History of dry cough since 1 month. History of Easy fatigability, Occasional frontal headache. No history of tinnitus, ear ache, cold, chest pain, palpitations, burning micturition, melena, hemoptysis, blood in stools, abdominal pain.
Now admitted for further evaluation and treatment.

PAST ILLNESS:
Surgical History:-
S/P tubectomy in 1997( at 25 years of age).
She had complaints of excessive, prolonged  and painful menses for which she sought for consultation and she underwent -Hysterectomy in 1998 (at 26 years of age) for AUB.
In 2017 (at 44 years of age) she had complaints of dry cough and fever and was diagnosed to be having Pulmonary TB, she was on ATT for 6 months after suputum negative confirmation.
Since 2019 ( 46 years of age) she was having joint pains involving wrist joint, MCP joint, PIP joint, Tarsal joints and MTP joint; History of early morning stiffness relieved on working associated with joint swelling; she was diagnosed as Hyperthyroidism at the same time and started on Carbimazole 10 mg once a day.
In the end of December, she had an episode of giddiness for which she sought for consultation and upon further evaluation, she was having low Hb (< 2.6 gr%); 2 units of PRBC transfusion was done. History of similar episode in the month of July and again she was transfused with 2 units of PRBC.

GENERAL EXAMINATlON:
Patient was conscious and coherent
Thin built
Pallor 
No cyanosis/ clubbing/ lymphadenopathy/ Icterus.
Hyperpigmented tongue, palms and knuckles.
CVS : S1,S2 +, No added sounds.
R/S : BAE+, Clear.
P/A : Soft, Non tender, No organomegaly.
CNS: NFND.


ECG at presentation:

FEVER CHART:

Peripheral Smear on day of presentation and spot urine protein and creatinine:
COOMBS TEST:
24 hour urinary creatinine 0.5 g/day
24 hour urinary protein 1140 mg/day 
24 hour urinary volume 1900 ml/day

INVESTIGATION CHART:

USG ABDOMEN:
CHEST X RAY PA VIEW:

CHEST X RAY REPORTING:
2D ECHO:





Radiological images of both hands and foot:

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