65M with filariasis and multiple blisters on right leg

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome."I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan


65 yr old male resident of nalgonda weaver by occupation came to OPD with 

Chief complaints
Swelling in the right lower limb and scortum since 5 days 
Multiple blisters on the leg since 5 days
Fever since 5 days 

History of presenting illness 
He was apparently asymptomatic 5 days ago then he developed swelling in right lower limb upto thigh (gradually progressive from foot to thigh)along with scortum which is associated with pain - sudden in onset , gradually progressive , pricking type, aggravated on walking , releived on rest 
Multiple blisters on right leg, associated with local rise of temperature, moderate fever(102°f),skin changes, pigmentation 
Not associated with burning micturation, urinary incontinence

Past history 
Known case of filariasis since 15 yrs and on medication ( Diethylcarbamazine)
Not a k/c/o HTN,DM , epilepsy,TB,CAD,CVD,asthma

Personal history
Diet :mixed
Appetite : decreased 
Sleep: adequate
Bladder and bowel movements : normal and regular 
Addictions : consumes alcohol occasionally
No allergies

Treatment history 
Diethylcarbamazine since 15yrs (takes medicine only after noticable swelling)
Chymoral forte -takes when there is pain 

Family history
Non significant

General examination 
Patient is conscious,coherent and cooperative
Well oriented to time place and person
Moderately built and nourished
No pallor,icterus, cynosis, clubbing, koilonychia,
Lymphadenopathy:enlarged inguinal and popliteal lymph nodes
Pedal oedema -pitting type ,from foot upto thigh

Vitals 
Bp:100/60 mm hg 
Temp:98 
RR:21cpm
PR:78bpm














Systemic examination
CVS:S1,S2 heard ,no murmurs
CNS: no focal neurological deficit
Resp: Bilateral air entry present,normal vesicular breath sounds heard 
Per abdomen: soft and non tender 


Investigations





Treatment history
 1)IV fluids (normal saline 75ml/hr)

2) Inj.PAN 40 mg OD

3)Tab.Dolo 650 mg 

4) Inj. NEOLOL 1gm 

5) Inj.PIPTAZ 4.5gm 













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