CASE HISTORYCASE HISTORY NAME NAME :: MARJINA BEGUM MARJINA BEGUM AgeAge :: About 25 yearAbout 25 year SexSex :: FemaleFemale Marital Status:Marital Status: MarriedMarried OccupationOccupation :: House wife.House wife.

Address :Address : Vill : Kujghar, Vill : Kujghar,

Post : Kujghar,P.S.: Sadar, Post : Kujghar,P.S.: Sadar,

Dist : Jamalpur.Dist : Jamalpur.

Date of Admission:Date of Admission: 08-11-200508-11-2005

Date of Examination:Date of Examination: 09-11-200509-11-2005

CHIEF COMPLAINTSCHIEF COMPLAINTS Diffuse painful blisters & crusted Diffuse painful blisters & crusted

lesions over scalp, face, trunk, lesions over scalp, face, trunk, upper extrimities & groin.For about upper extrimities & groin.For about 1½ month. A few small blisters in 1½ month. A few small blisters in mouth cavity For 7 days. mouth cavity For 7 days.

H/O PRESENT ILLNESS

The patient states that she was all

right about six months back. Then

she developed a few blisters with

itching at lower part of back of Lt

painful blisters

side. Subsequently after 4 months she

developed various sizedassociated with

itching at her chest, back, upper

extrimities, scalp, face, groin & a few

painful lesions is oral mucous membrane

which became crusted,

With above complaints she was With above complaints she was admitted in Mymensingh Medical admitted in Mymensingh Medical College Hospital for proper College Hospital for proper management. exfoliative, management. exfoliative, reddened with moist surface reddened with moist surface

H/O PAST ILLNESSH/O PAST ILLNESS. .

Nothing contributory.Nothing contributory. Personal History: Married for 4 years.Personal History: Married for 4 years.

No issue.No issue.Menstruation : Regular.Menstruation : Regular.HabitHabitchewing of battlechewing of battle

nut +nut +

Family History:Family History: No any of herNo any of herfamily members family members suffered from anysuffered from anysuch notable such notable disease. disease.

Treatment History:Treatment History: Patient was Patient was

admitted with complaint mentioned in admitted with complaint mentioned in

MMCH on 20-10-2005 & was treated MMCH on 20-10-2005 & was treated

with long acting steroid triamcinolone with long acting steroid triamcinolone

acetonide parenterally & was improved. acetonide parenterally & was improved.

GENERAL GENERAL EXAMINATION.EXAMINATION. AppearanceAppearance :: Ill looking.Ill looking. Body build Body build :: Average.Average. AnaemiaAnaemia JaundiceJaundice Absent. Absent. Cyanosis Cyanosis

Oedema Oedema DehydrationDehydration ClubbingClubbing Koilonychia Koilonychia HairHair NailNail

AbsentAbsent

AbsentAbsent

NormalNormal

PulsePulse : 86/min/reg/mod. : 86/min/reg/mod. B.PB.P : 120/35mm of Hg. : 120/35mm of Hg. TempTemp : : NormalNormal Respiration : 14/min.Respiration : 14/min. Neck veins : Not engorged.Neck veins : Not engorged. Lymph Node : Not palpable.Lymph Node : Not palpable.

EXAMINATION OF EXAMINATION OF INTEGUMENTARY SYSTEM.INTEGUMENTARY SYSTEM.

Inspection Vesicles & bulla on

scalp, face, chest, back, upper

extrimities, groin, some on normal skin &

some are erythomatous based.

Crust & erosions with scaling in

some areas & superfical ulceration in oral

cavity.

Palpation :Palpation : Vesicles & bullae are Vesicles & bullae are

flacid, tenderness present flacid, tenderness present

NIKOLSKY Sign - NIKOLSKY Sign -

Present.Bulla – spread Present.Bulla – spread

plenomenon (The Asboe- plenomenon (The Asboe-

Hansen sign) – Present.Hansen sign) – Present.

EXAMINATION OF OTHER SYSTEM :

NAD except a few oral mucosal

lesions.

SALIENT FEATURES.SALIENT FEATURES.

Marjina Begum, Age about 25 years Marjina Begum, Age about 25 years of vill Kujghar, Jamalpur was admitted of vill Kujghar, Jamalpur was admitted in MMCH on 08-11-05 with complaints in MMCH on 08-11-05 with complaints of progressive development of painful of progressive development of painful blisters. Crust, erosions & exfoliative blisters. Crust, erosions & exfoliative lesions associated with itching lesions associated with itching

over scalp, face, trunk, upper arms, over scalp, face, trunk, upper arms,

groin & a few small painful blisters in groin & a few small painful blisters in

oral cavity. Examination shows flaccid oral cavity. Examination shows flaccid

& vesicles, Bullae, crusted & & vesicles, Bullae, crusted &

exfoliative lesions with erythomatous exfoliative lesions with erythomatous

base at the mentioned sites. The base at the mentioned sites. The

lesions are lesions are

tender, moist with malodourous

condition & a few superficial erosions in

oral mucous membrane.

Nikolsky sign – Present

Bulla – Spread Phenomenon

– Present.

PROVISIONAL DIAGNOSIS. Pemphigus foliaceous. D/D.: Pemphigus Vulguris.

Pemphigus vegetans.Bullous Pemphigoid.SSSSCicatrical Pemphigoid.Stevens johnson syndorme & TEN.

INVESTIGATION.INVESTIGATION. Skin biopsy for Histopathology & IF Skin biopsy for Histopathology & IF test.test. Blood for TC DC Hb% ESR -Blood for TC DC Hb% ESR - 6600/cmm. N-6600/cmm. N-

62%, L-32%,62%, L-32%,M-02%, E-0%, Hb%-M-02%, E-0%, Hb%-80%,ESR-80%,ESR- 10mm/1st 10mm/1st hour. hour.

Random blood suger.-Random blood suger.- 103mg/100 ml.103mg/100 ml. Urine for R/E.Urine for R/E. - - NAD NAD Blood Urea.Blood Urea. - 18mg/100ml. - 18mg/100ml. Serum creatinine.Serum creatinine. - 1.0mg/100ml. - 1.0mg/100ml.

BIOPSY FOR HISTOPATHOLOGY :BIOPSY FOR HISTOPATHOLOGY : Finding :Finding : Pemphigus compatible Pemphigus compatible with with pemphigus foliaceous. pemphigus foliaceous.

CONFIRMATORY DIAGNOSIS. CONFIRMATORY DIAGNOSIS. Pemphigus foliaceous.Pemphigus foliaceous.

TREATMENT.TREATMENT. Inj. Inj. -- TRIAMCINOLONE TRIAMCINOLONE ACETONID ACETONID

1AMP I/M stat 1AMP I/M stat and 1amp on 3rd and 1amp on 3rd day & 1 day & 1 amp on 7th day.amp on 7th day.

Tab.Tab. -- Prednisolon -80mg/day.Prednisolon -80mg/day. Tab.Tab. -- Neotack (150mg) 1+0+1 daily.Neotack (150mg) 1+0+1 daily.

TREATMENT(Contd).TREATMENT(Contd). Cap.Cap. -- Sefradine Sefradine

(500mg)1+1+1+1 (500mg)1+1+1+1 daily.daily. Tab.Tab. -- Alatrol 0+0+1 daily.Alatrol 0+0+1 daily. Potash wash - daily.1% Silver Potash wash - daily.1% Silver

sulphadiazine ointment -sulphadiazine ointment -daily.daily.

SALIENT FEATURE.

Mr. Sumon Das, son of Dr. Kanu Das,

aged 29 years hailing form Jamalpur

was admitted in MMCH, Cabin-7 on

28th November,2005. He was referred

to skin & VD OPD on 30th Nov. 05

with the complaints of exfoliation of

skin with generalized mild itching skin with generalized mild itching for 20 days, a known case of for 20 days, a known case of hypothyroidism due to hypothyroidism due to thyroidectomy 3 months back & thyroidectomy 3 months back & bronchial asthma from childhood. bronchial asthma from childhood. On examination we found On examination we found extensive scaling all over the skin extensive scaling all over the skin with erythemawith erythema

and itching, mild leg oedema & and itching, mild leg oedema & puffy face. Pt’s pulse was 96/min, puffy face. Pt’s pulse was 96/min, BP= 120/65 mm of Hg, temp. = BP= 120/65 mm of Hg, temp. = 101.40F, lungs, heart & urinary 101.40F, lungs, heart & urinary output – normal. There was no output – normal. There was no mucous membrane and nail mucous membrane and nail changes. Pt. also complaints of changes. Pt. also complaints of

chilling & gave H/O taking tab.

Ibuprofen 20 days back and also

paracetamol & azithromycin. With

these above features our diagnosis is

drug induced exfoliative dermatitis.