DERMATOMYOSITIS WITH PRIMARY INFERTILITY
CHIEF COMPLAINS:
- Bilateral joint pains (knees) since 10 months
- Bilateral itching in the upper aspect of chest and neck since 10 months
HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic 10 months ago. Then she developed symmetrical bilateral joint pains in the knees which was insidious in onset, gradually progressive, no aggravating factors and relieved on medication
TAB HYDROXYCHLOROQUINE SULPHATE (200mg)
Associated with morning stiffness. Around the same time she developed itching over neck and upper chest area.
As a result of the itching, the area was initially red and turned black.
- C/O Alopecia since 10 months which was gradually progressive leading to severe hair loss over the past 10 months. Associated with thinning of hair.
- C/O bilateral pitting type of pedal Edema and Edema over the dorsal aspect of hands.
- C/O generalised pain.
- C/O Difficulty in walking.
- C/O distal muscle weakness manifested in the form of - difficulty in mixing food, eating with hands, buttoning- unbuttoning of shirt, combing of hair.
- C/O proximal muscle weakness manifested in the form of - difficulty in getting up from squatting position, getting objects present at a height.
- C/O Dyspnea on exertion (NYHA- 3), gradually progressive since 4-5 months.
- C/O vaginal discharge since 7-8 months. It was initially curdy white which later changed to watery discharge. Associated with itching.
- C/O weight loss of 4 kg over the last 10 months.
- C/O oral ulcers and genital ulcers since 10 months.
- No history of fever, cold, cough.
PAST HISTORY:
Not a known case of DM, HTN, BA, epilepsy, Asthma, CVA, CAD.
No similar complaints in the past.
MENSTRUAL HISTORY:
Age of maturity - 11 years
3/25-28, regular , no pains, no clots.
MARITAL HISTORY:
ML- 14 years, NCM. Primary infertility (Nulligravida) has recently adopted a girl from her sister-in-law.
FAMILY HISTORY:
No similar complaints in the family.
PERSONAL HISTORY:
Diet- Mixed.
Appetite- Decreased.
Sleep- Inadequate since 10 months.
Bowel and bladder habits- Regular.
- No addictions.
- No known drug allergies.
GENERAL PHYSICALEXAMINATION:
The patient is conscious, coherent, cooperative well oriented to time, place and person. She is moderately built and moderately nourished.
Pallor- present.
Icterus- absent.
Cyanosis- absent.
Clubbing- absent.
Lymphadenopathy- absent.
Pedal Edema- present.
EXAMINATORY FINDINGS:
- Diffuse mottled erythematous hyperpigmentation (Heliotrope rash) noted on B/L cheeks, nose(bridge) involving nasolabial folds, ears, neck extending onto upper chest and back forming a ‘V’ on anterior chest (Shawl sign).
- Few hyper-pigmented macules noted on mid and lower back (‘V’ sign).
- Single erythematous macule noted over the right loin (Holsier sign).
- Pigmentation of B/L knuckles noted (Gottron’s Papules).
VITALS:
Temperature- Afebrile.
BP- 130/80 mm Hg.
PR- 85 bpm.
RR- 14 cpm.
SpO2- 98% @ RA.
SYSTEMIC EXAMINATION:
CVS- S1, S2 sounds heard. No murmurs
RS- BAE+ NVBS heard
CNS- NAD
P/A- Soft, non tender, Bowel sounds heard
PROVISIONAL DIAGNOSIS:
DERMATOMYOSITIS WITH PRIMARY INFERTILITY
GENITAL CANDIDIASIS
?SLE
DVL REFERRAL WAS TAKEN-
INVESTIGATIONS:
RA Factor- Negative
CRP- Negative
TREATMENT:
