case study leprosy

leprosy case scenario

1. PBL WRAP UP CASE 1

2. Patient Particulars Mr. Shah, 21 years male from janakpur , working as a labour presented to DH with chief complaint of, Discoloration of skin over right arm since 4 months Weakness of right wrist since 1 month

3. HISTORY OF PRESENT ILLNESS According to patient he was apparently well 4 months back when he developed, Discoloration of skin over right arm, which was single in number, over anterior aspect, shiny white in appearance. It was associated with numbness of skin around that lesion . He also complained of weakness of right wrist, which was gradual on onset associated with numbness of skin over little finger and ring finger and claw like deformity . It was severe enough to restrict his daily activities . .

4. FAMILY HISTORY There are 8 members in his family. No history of chronic illness. History of similar illness in his brother 1 year back, for which he had taken some medications.

5. EXAMINATION A well looking, thinly build, cooperative, oriented to time place and person is sitting comfortably without any particular decubitus of choice. No pallor, icterus, Cyanosis Assessable lymph nodes not palpable No clubbing, edema, dehydration Vitals within normal limits

6. LOCAL EXAMINATION A well-defined, about 5*2.5cm in size, single, hypo pigmented patch with erythematous border present over right arm Decreased sensation to touch and pressure over the lesion Thickened, hard cord like structure palpated over medial epicondyle. Ulnar claw present.

7. INVESTIGATIONS: Slit smear taken from skin lesion, positive for AFB Histopathology, Showing epidermal atrophy and presence of epitheloid cell granuloma with gaint cell Lepromin test: Positive

8. Provisional diagnosis: Tuberculoid leprosy with ulnar claw. Patient was then prescribed with Multi Drug Therapy. Patient then progressed and was regaining normal function after physiotherapy.

9. CASE 2

10. PATIENT PARTICULARS Ms Sharma, a 14 years Hindu girl from Dhulikhel-9, Kavre , student, presented to the Dhulikhel Hospital Orthopedics Out-Patient Department (OPD) with the chief complaints of:- Fever since 4 days Right knee pain and swelling for 4 days

11. HISTORY OF PRESENT ILLNESS According to the patient, she was apparently well 4 days back when she started having fever , which was continuous, acute in onset, max temperature recorded was 101 F, a/w chills and rigors and sweating. The fever was relieved on taking oral medications and cold sponging. She also complains of Right knee pain and swelling for 4 days , that was acute on onset, dull aching, non radiating, aggravated on walking, relieved on taking rest and medications, severe enough to affect her daily activities. It was associated with diffuse spasm of legs over backside The pain was associated with swelling over right knee, acute on onset, increasing in size since past 4 days.

12. HISTORY OF PAST ILLNESS History of RTA 7 days back, after which she had sustained injury over lower limbs. No history surgery

13. EXAMINATION An ill-looking, thinly built girl is sitting on the chair. She is conscious, co-operative and well-oriented to time, place and person. PILCCOD: No pallor, icterus, cyanosis, assessable lymph nodes not palpable, no clubbing, edema, dehydration Vitals: She is having fever of 100 F. Pulse, BP, JVP and Respiratory Rate are within normal limits

14. LOCAL EXAMINATION A well defined, about, 4*3cm in size , swelling present over right knee, reddish, raised temperature, tender, with no any rashes. Soft in consistency, not attached to skin Non fluctuating, non mobile Restricted joint mobility

15. INVESTIGATIONS Blood examination revealed polymorphonuclear leukocytosis. CRP : raised ESR:raised X-ray of the limb revealed lytic area with surrounding sclerosis in the metaphyseal region of tibia.   Aspiration from the swelling was sent for culture and sensitivity

16. Patient Progression The reports from culture , Staph aureus was isolated and sensitive to Cloxacillin. Treatment: The child was admitted In Ortho ward and planned for conservative management with IV antibiotics and fluids support. Provisional diagnosis: 14 yrs old girl with Acute Osteomyelitis