AZATHIPRINE INDUCED PANCYTOPENIA WITH MCTD AND RETINAL VASCULITIS.pdf

Autoimmune diseases, ganapathi, azathioprine induced pancytopenia with MCTD and Retinal vasculitis, disease, diagnosis, treatment, patient counseling,

1. AZATHIPRINE INDUCED
PANCYTOPENIA WITH MCTD
AND RETINAL VASCULITIS
V. GANAPATHI
19353D1009
PHARM. D VI YEAR
JAYAMUKHI COLLEGE OF PHARMACY
GANAPATHIGREAT369

2. SUBJECTIVE FINDINGS
A female patient of age 28 years old came to the hospital with following
C/O:
•Fever with headache and throat pain since 2 days
•Blurry vision and generalized weakness +
K/C/O:
i.Polyarthritis
ii.Raynaud’s phenomenon since 2 years
iii.UCTD → MCTD
iv.Lichen planus
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3. SUBJECTIVE FINDINGS
S/H/O:
•LSCS- 4 years back
M/h/o:
•Tab. Azaron 50mg OD since one month
•Side Effects seen: hair loss, oral ulcers, rashes and itching+
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4. OBJECTIVE FINDINGS
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S.N VITALS INITIAL DAY-1 DAY-2
1 ON EXAMINATION C/C/C C/C/C C/C/C
2 PULSE RATE (bpm) 86 92 82
3 B.P. (mmHg) 113/77 120/70 128/78
4 SpO2 (%) 99% on RA 100% on RA 98% on RA
5 TEMPERATURE (*F) Afebrile Afebrile Afebrile
6 LUNGS NVBS NVBS NVBS
7 PARA ABDOMEN Soft Soft Soft
8 HEART S1 S2+ S1 S2+ S1 S2+
9 GCS SCORE (15) E4V5M6 E4V5M6 E4V5M6
•NOTE: B.P- Blood Pressure, C/C/C- conscious/ coherent/ cooperative, SpO2- saturation of peripheral
oxygen, GRBS- general random blood sugar, NVBS-normal vesicular breath sounds and RA- room air.

5. LAB INVESTIGATIONS
GANAPATHIGREAT369
S.N PARAMETER NORMAL RANGE RESULTS
1 Haemoglobin (gm) 12-16 7.6
2 RBC Count (M/cumm) 4.5-5.5 2.37
3 WBC Count (C/cumm) 4000-11000 400
4 Platelet Count (L/cumm) 1.5-4.5 45000
5 Urea (mg/dl) 20-40 30
6 Serum Creatinine (mg/dl) 0.7-1.2 0.9
7 Serum Sodium (mmol/L) 136-145 133
8 Serum Potassium (mmol/L) 3.6-5.1 4.1
9 Serum Chloride (mmol/L) 98-108 110
NOTE: M/cumm- million/cubic millimeter, C/cumm- cells/cubic millimeter, gm- gram, L/cumm- lakh/
cubic millimeter, mg/dl- milligram/ deciliter and mmol/L- millimole/litre.

6. LAB INVESTIGATIONS
GANAPATHIGREAT369
S.N PARAMETER NORMAL RANGE RESULTS
1 Serum Ferritin (ng/ml) 13-150 284.4
2 Serum Fibrinogen (mg/dl) 150-400 210
3 Urine Protein (mg/dl) 9.91
4 Urine Creatinine (mg/dl) 16-327 97.1
5 Protein Creatine ratio <0.2 0.10
6 CRP (mg/dl) 0-0.75 31
7 Serum Procalcitonin (ng/ml) 0.5 0.11
8 Pus Cells in Urine (HPF) 0-5 6-8
9 Epithelial Cells in Urine (HPF) 15-25 10-12
NOTE: M/cumm- million/cubic millimeter, C/cumm- cells/cubic millimeter, gm- gram, L/cumm- lakh/
cubic millimeter, mg/dl- milligram/ deciliter and mmol/L- millimole/litre.

7. LAB INVESTIGATIONS
GANAPATHIGREAT369
S.N TEST RESULTS
1 BLOOD CULTURE/ SENSITIVITY NEGATIVE
2 URINE CULTURE/ SENSITIVUITY KLEBSIELLA OXYTOCA+
3 PV/ PF NEGATIVE
4DIRECT COOMS TEST (ANTIGLOBULIN) NEGATIVE
5 DENGUE- NS1, IgM, IgG NEGATIVE
6 LFT NORMAL

8. ASSESSMENT
❑On the basis of subjective, objective and imaging finding confirms
that the patient has been diagnosed with-
AZATHIOPRINE INDUCED PANCYTOPENIA WITH MCTD AND
RETINAL VASCULITIS.
❑K/C/O:
i.Polyarthritis
ii.Raynaud’s phenomenon since 2 years
iii.UCTD → MCTD
iv.Lichen planus
GANAPATHIGREAT369

9. PHARMACOLOGICAL THERAPY
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S.N BRAND DRUG DOSE R.O.AFREQUENCY DURATION
1 PIPZO PIPERACILLIN&
TAZOBACTUM
4GM/500
MG
IV THRICE D1-D5
2FILGASTRIM FILGASTRIM 300MCG IV ONCE D1-D3
3 RABEZOLE RABEPRAZOLE 20MG IV ONCE D1-D5
4 NEOMOL ACETAMINOPHEN 500MG IV 6
TH
HOURLY D1-D2
7 IVAPRED PREDNISOLONE 10MG PO ONCE D1-D5
8 MVI MULTI VITAMINS 1TAB PO ONCE D1-D5

10. PATIENT EDUCATION
❖Take medication as advised by the doctor regularly
❖Drink minimum of 1.5 liter per day
❖Eat fresh fruits and vegetables
❖Avoid direct contact with pet animals and contaminated things
❖Regular bath with moderate hot water
❖Seek immediate medical care in case of any unwanted side effects
❖Regular physical exercise and walking
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11. HAVE A GOOD DAY
[email protected]
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