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- Chief complaints:
Moderate to high grade fever since 6 weeks , Rash all over body since 6 weeks difficulty swallowing since 6 weeks , Dypsnea on exertion grade 4 since 4 weeks , raynauds phenomenon since 3 weeks . Hair fall , severe fatigue – 3 weeks Loss of vision in both eyes since 1 yr Past history:ver with irrelevant talk in 2009 —–treated for 1 yr with no result 2011 – decreasion vision in both eye with total loss of vision within 6 months . - Lab tests:
ANA + , DsDNA – neg , anti – SM –neg , C3,c4 – low , ESR – 62 , cretinine- 0.8 , WBC – 27, 600 , Hb – 9.6 , platelets – 1,40,000 , Na – 119 , Urine – proteins 2+, rbc – 8-10 , pus cells – abundant . ANTI UNRNP 1 + 2Decho – PAH – 65 SEVERE PH COURSE IN HOSPITAL: Treated infection with antibiotics , corrected hyponatrenia, , once WBC count stabilized after 1 week ,Started in high dose methlyprednisolone 1gm daily for 3 days , tadalafil 20mg od for PAH , and then inj rituximab 1gm was given and repeated after 15 days . - At the end of 3 months pt. is well able to walk , eat , no rash no joint pains , , vision – can see flashes of light hence referred to retina surgeon.
- On going treatment:
Hydroxychloroquine 200mg bd Azoran 25 mg od Folvite 5 mg twice a week