General medicine case-8

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A 22 year old female patient daily labour  by occupation came to our OPD on 5.11.21 with the camplaint of swelling  in the left lower limb  since 1 month .

History of present illness:- 

-Patient was apparently asymptomatic 1 year  back  ,then she developed round skin lesions for which she visited local hospital .

-There patient prescribed some medication which she used for 3 -4 months .

-As the lesions donot subside she again visited to hospital and took some injections for 3-4months.

- Again the lesions did not subside /relieved then she came to our hospital and took some medication and the lesions are relieved .

-3months back patient suffered with fever for which she underwent some tests ,there she came to know that she was diabetic.

-Patient prescribed metformin for diabetes.

-Patient has h/o of swelling since 1 month with pus discharge for which she underwent some aseptic dressing for 1 week.

-Later swelling progressed with pain for which she is unable to walk.

-H/O decreased urine output since 1 month .

-Facial puffiness since 3 months.

Past history :- 

- No history of hypertension, asthama, epilepsy, previous surgery.

Personal history:-

-Diet :- mixed 

-Appetite:- decreased

-sleep :- normal 

-bowel and bladder movements:- constipation, decreased urine output.

Family history:- 

-Patient father has history of diabetes mellitus and similar skin lesions 1 yr back .

Drug history:- 

-No history of allergy to known drugs.

General examination:- 

-Patient  is conscious ,coherent, cooperative and well oriented to surroundings.

-No history of icterus, cyanosis, clubbing, pallor, lymphadenopathy.

Vitals :- 

-Temparature:- Afebrile

-PR :- 92 beats /min 

-RR :- 18 cycles/min 

- SPO2 :- 98%

-GRBS :- 372 mg %

Systemic examination :- 

-CVS :- S1,S2 +,No murmurs heard .

-Respiratory system:- Bilateral air entry is normal.

-Palpation /Auscultation:- soft ,nontender ,bowel sounds+

-CNS :- No neurological defects.

Investigations:- 

ECG:-

X-ray :-

Diagnosis :- 

-Iatrogenic Cushing syndrome with h/o of tenia corporis .

Left lower limb cellulitis with uncontrolled type 2  diabetes mellitus .

Treatment:- 

-IVF - NS,RL

-INJ.ZOSTUM 1.5GM IV BD

-INJ. HAI S/C PREMEAL TID

-INJ. TRAMADOL 1AMP IN 100ML NS IV BD

-TAB. CHYMORAL FORTE PO TID

-TAB . DOLO 650MG PO SOS 

-SYP. POTCHLOR 10ML PO