Final diagnosis :
CHRONIC PLAQUE PSORIASIS with Left INGUINAL HERNIAand hydrocele
61 year old male,civil engineer from west Bengal, came to medicine department with chief complaints of itchy skin lesions on buttocks,legs,hands,thigh since 40 years.
patient was apparantly asymptomatic 40 years ago then he developed a a itchy, red lesion at the base of the penis, which gradually spread through out the body associated with burning type of pain and itching, constant in nature aggravated on exposure to sun , relieved by blowdrier.
PAST HISTORY :
k/c/o psoriatic arthritis since 43 years ( relieved from
k/c/o chronic bronchitis since 42 years
k/c/o BPH also have kidney stones of 4mm size.
k/c/o DM and Hypertension since 4 months
PERSONAL HISTORY:
Water intake:- normal (2L max.)
Appetite:-normal
Diet:- mixed
Bowel movement:- Constipation. not able to pass stools , only passes after medication.
bladder movement:-Polyuria
Addictions:- Consumes supari.
Alcohol:- none
Smoking:- doesn't smoke, stopped smoking 30 years ago
Allergies:- none.
Exercise status:- Patient used to do pranayam in the morning for 30 minutes. For the last 2-3 months, the patient doesn't do pranayam anymore.
FAMILY HISTORY
Mother is a known case of rheumatoid arthritis.
TREATMENT HISTORY
Methotrexate 10 mg used for 13 months
Tofacitinib used for 3 months for arthritis.Etoricoxib, folinic acid also used .
Patient is on different treatments ( homeopathic,allopathic, ayurvedic ) from past few years.
Course in hospital :
DAy 1 c/s/by DERMA , asked for review after reports diagnosed as chronic PLAQUE psoriasis
patient has been managed by symptomatically.
Patient history and musculo skeletal examination done and found to be normal except for his right hip pain
DAY 2 patient was investigated further investigations sent .as his BP increasing, TELMA 20 was added
DAY 3 Patient found to have inguinal hernia along with hydrocele , surgery referral was done.
Day 4 , patients derma review referral was done , in which patient has been advised medications.
ADVICE AT DISCHARGE:
TAB ACETRETIN 25 mg OD
TAB NMFE LIP BALM
VENUSA MAX COTTON L/A BD × 2 weeks
HAWS- X L/A OD× 2WEEKZ
TAB TECZINE 10 mg OD×2 weeks
TAB PAN 40 MG po/OD
TAB TELMA 20MG PO/OD.
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