Disclaimer:
This is a HIPAA de-identified open-online-patient-record posted here autumn 2016 after collecting informed patient consent (form downloadable here ) by Sumedha Dhar, 3rd Semester, MBBS, WBUHS, West Bengal
A 40 year old woman presented with numerous erosions on her face,neck and eyes. She also presented erosions inside her mouth and complained of increased salivation with difficulty in swallowing associated with a burning sensation on trying to swallow food.
Her medical history showed similar case a about 8 months back when she was admitted to the female ward on reference from the Dermatology department after pemphigus vulgaris was suspected and she was treated after which her conditions improved and she was discharged to home care. ( Editor's/Facilitator's note to history taker: Sumedha please let us know how the diagnosis in her case was confirmed).
On investigation Type2 Diabetes mellitus was also detected.
She was absolutely well for 3-4 months,when again one day she noticed some small eruptions on her back which looked like those of chicken pox. Gradually these eruptions kept spreading on her upper part of chest,neck,then her face and buccal cavity and finally her eyes. These eruptions burst with pus like discharge that had burnt smell.
This time the condition worsened as there was inflammation over her eyes and she couldn't open them which was not present in the previous episode of pemphigus.She initially had complained of pain associated with itching, but at present has no such complains.
She was treated with Dexamethasone,10℅light liquid paraffin,clobetasol and gentamicin.
Sumedha What was/is being done for her diabetes?
Discussion:
As we wait for Sumedha to find out how the diagnosis was confirmed in our patient we can take a look at how the usual pemphigus vulgaris patient's skin looks under the microscope? Here's an illustrative image borrowed from: http://www.slideshare.net/medicaldump/pemphigus-vulgaris
This is a HIPAA de-identified open-online-patient-record posted here autumn 2016 after collecting informed patient consent (form downloadable here ) by Sumedha Dhar, 3rd Semester, MBBS, WBUHS, West Bengal
Her medical history showed similar case a about 8 months back when she was admitted to the female ward on reference from the Dermatology department after pemphigus vulgaris was suspected and she was treated after which her conditions improved and she was discharged to home care. ( Editor's/Facilitator's note to history taker: Sumedha please let us know how the diagnosis in her case was confirmed).
On investigation Type2 Diabetes mellitus was also detected.
She was absolutely well for 3-4 months,when again one day she noticed some small eruptions on her back which looked like those of chicken pox. Gradually these eruptions kept spreading on her upper part of chest,neck,then her face and buccal cavity and finally her eyes. These eruptions burst with pus like discharge that had burnt smell.
This time the condition worsened as there was inflammation over her eyes and she couldn't open them which was not present in the previous episode of pemphigus.She initially had complained of pain associated with itching, but at present has no such complains.
She was treated with Dexamethasone,10℅light liquid paraffin,clobetasol and gentamicin.
Sumedha What was/is being done for her diabetes?
Discussion:
As we wait for Sumedha to find out how the diagnosis was confirmed in our patient we can take a look at how the usual pemphigus vulgaris patient's skin looks under the microscope? Here's an illustrative image borrowed from: http://www.slideshare.net/medicaldump/pemphigus-vulgaris
Conversational Clinical decision support:
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