| Study 1 | Erythematous plaques | Dermatology |
|---|---|---|
| Study 2 | Painful Swelling in the Forearm | Radiodiagnosis |
| Study 3 |
Repeated miscarriage following surgery for Pituitary Macroadenoma |
Endocrinology |
| Study 4 | Cold and Comatose | Medicine |
Study 1: DERMATOLOGY
Erythematous plaques
Courtesy: Department of Dermatology, CMC, Vellore.
We continue the Series of Spotters in Dermatology kindly contributed by Dr. Renu George, Professor of Dermatology, CMC, Vellore. This is the series on "The Skin In Connective Tissue Disorders".Dermatology Spotter Series 1; No.2.
This patient presented with fever of 2 month duration associated with photosensitivity and extensive lesions all over the face
1. Describe the skin lesion in this patient.
Click on the picture to enlarge.
2. What is your diagnosis in this patient?
3. How would you describe the lesions in this young man?
4. What is your diagnosis?
5. What are the common skin lesions seen in SLE?
Acknowledgement: Submitted by Dr. Renu George, Department of Dermatology, CMC, Vellore.
Study 2: RADIODIAGNOSIS
Painful Swelling in the Forearm
Courtesy: Department of Radiodiagnosis, CMC Hospital, Vellore.
Given below are the plain radiograph of the knee and bone scintigraphy images of a 63 year old male patient, who was investigated for painful swelling in the forearm.Click on the picture to enlarge.
1. What are the radiological findings and what is the complete diagnosis?
2. What are some of the causes for this type of arthropathy?
Image 3 (Click on the picture to enlarge)
3. What is the underlying cause in this particular patient?
4. What are the imaging hallmarks of this condition?
5. What are the differential diagnosis?
Acknowledgement: Submitted by Dr. N. K. Shyam, Dr. Yvette Kirubha. J. and Dr. Leena, Department of Radiodiagnosis, Dr. Regi Oommen, Department of Nuclear Medicine, CMC, Vellore.
Study 3: ENDOCRINOLOGY
Repeated miscarriage following surgery for Pituitary Macroadenoma
Courtesy: Department of Endocrinology, CMC Hospital, Vellore.
PAST HISTORY
- A 33 year old lady was diagnosed to have a non-functioning Pituitary Macroadenoma in 1996 (symptoms that preceded were headache and vomiting).
- She had then undergone Transfrontal surgery followed by Radiation therapy at another centre.
- She remained amenorrheic since then and was started on Thyroxine.
- She desired pregnancy and in 1998 conceived through Assisted Reproductive.
- Techniques and aborted at 6 weeks.
1. What are the findings you observe on the MRI image?
Click on the picture to enlarge.
2. What were the possible after effects of surgery in this patient?
3. What is the incidence of this condition in infertility clinics?
RECENT HISTORY
In 2002, She came for assessment to CMC and clinical examination was unremarkable and her hormonal profile was as follows:- TSH:0.092IU/ml,
- Free Thyroxine concentration:0.91(ng%)
- FSH:0.37(m IU/ml)
- LH:0.15(m IU/ml)
- Cortisol:8.57 mcg%
4. How would you interpret the laboratory findings?
FOLLOW UP
- She opted for Assisted Reproductive Therapy (ART) in December 2002 and required large doses of HMG (Human Menopausal Gonadotropin), up to 225 IU/day.
- She conceived, but did not return for follow up and had a spontaneous miscarriage once again
5. What was the possible cause of the miscarriage?
PRESENT HISTORY
- During a recent visit in May 2003 she was restarted on HMG and Intrauterine Insemination was performed with which she conceived and she also received luteal support in the form of intra-vaginal progesterone.
- She is currently well in the 6th month of pregnancy.
6. What are the causes of Hypogonadotrophic Hypogonadism?
7. What are the special problems of pregnancy in hypogonadotrophic hypogonadism?
Acknowledgement: Submitted by Dr. Nihal Thomas, Department of Endocrinology, CMC, Vellore.
Study 4: MEDICINE
Cold and Comatose
Courtesy: Department of Medicine - Unit I, CMC Hospital, Vellore.
HISTORY
A lady of approximately 40 years of age presented with a history of- 5 days of swelling of the body
- Swelling of the thigh
- ? Fever
- Not responding well for 1 day
PAST HISTORY
- Anasarca
- Conscious, disoriented
- Bp: 130/80 mm Hg. Pulse: 110/ min.
- Lungs: Occasional crepitations +
- Heart sounds not clearly heard
- JVP not elevated
- No hepato splenomegaly
- Cellulitis of right thigh noted
COURSE IN HOSPITAL
- Seen by surgeons and attempted I & D of thigh- only serous fluid obtained
- Investigations revealed a pre renal failure
- Sensorium progressively worsened- creatinine noted to be high- Medicine consult sought
- Transferred under Medicine
INVESTIGATIONS
- Hb: 12.3 gm%
- Total count: 11,000 with 80% neutrophils
- Creatinine: 2.2 mg%
- Na: 122 mEq/L, K: 5.5 mEq/L
CHEST X RAY
Click on the picture to enlarge.
1. What are the X'Ray Findings?
DIAGNOSIS
2. What is your Diagnosis?
3. What other investigation would you ask for?
TREATMENT
4. What treatment would you start?
Acknowledgement: Submitted by Dr. Subramaniam, Department of Medicine, CMC, Vellore.