45/F WITH LOWER BACKACHE UNDER EVALUATION ? LEFT HIP CHRONIC OSTEOMYELITIS , DM+ SINCE 3 MONTHS.
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Here is a case I have seen
Unit 6:
Case admitted on 20/2/2021.
Interns
K. Nikhil reddy
M. Swarna
K. Divya
B.Manivarma
Juveria
Dr. Vinay(pgy1)
Dr. A. Vaishnavi (pgy2)
Dr. Praneeth(pgy3)
Dr. Hareen (SR)
Dr.Praveen Naik( asst.prof.)
Dr.Rakesh Biswas (HOD)
A 45 yrs old female daily wager by occupation came with chief complaint of weakness of Left lower limb since 3 months.
History of present illness :
Patient was apparently asymptomatic 3 months back, then she complaints of fever 3 months back, associated with chills,continuous ,high grade ,not relieved With medication and went to local hospital for evaluation,Ocassional dry cough present, Vomitings- 2 episodes, contains food particles,non projectile,non bilious,non blood stained. loose stools -2 episodes ,There,she is diagnosed as Bilateral pneumonia ,Denovo diagnosed DM II, anemia relieved on medication of imipinem cilastin 500 mg TID and Amikacin 500 mg OD . She stayed in hospital for 20 days and came back to home, then She developed weakness of Left Lowerlimb .
C/O pain in Left Hip joint ,walking with support,after 1 month she is unable to walk alone with support, she observed crepitations in Lt hip joint while walking .she is unable to wake up from bed on her own ,sitting with support.
She also had complaints of lower backache since 3 months .
C/o pedal edema since 3 months ,pitting type extending upto knee, not relieved with medication.
No C/o cold, cough.
No C/O chest pain ,palpitations ,syncopal attacks.
No C/O constipation, loose stools, burning micturition.
Past history :
DM Denovo diagnosed 3 months back, for which she is on GLIMI M2 OD.
No H/o HTN , TB , asthma ,epilepsy, CVA, CAD.
H/o Blood transfusion : At mamatha hospital 1 PRBC transfusion ,In Nalgonda 2 PRBC transfusion .
Personal history:
Drinks toddy occasionally.
Family history:
Elder brother has diabetes .
Local examination:
No pallor,icterus, cyanosis,clubbing, lymphadenopathy .
Pedal edema +
Vitals :
Temperature- afebrile
PR- 84bpm
BP- 130/90 mmHg.
RR-18 cpm
Spo2-98% at room air
GRBS-182 mg/dl.
Systemic examination:
CNS:
Patient is conscious, oriented to time,place , person, cooperative.
Speech- normal
HMF- normal
Cranial nerves : intact
Motor examination:
Tone - normal
Power. Rt. Lt.
1.Shoulder:
Flexors-extensors. 4-/5 4+/5
Adductors. 4+/5 4+/5
Abductors. 4 -/5 4+/5
Lateral and medial rotator 4+/5 4+/5
2.Elbow:
Flexors-extensors. 4+/5 4+/5
3. Wrist:
Dorsi flexors-palmar flexor. 4+/5 4+/5
Abductors-adductors. 4+/5 4+/5
Pronators - supinators. 4+/5 4+/5
4. Hand grip. 100%. 100%
5. Hip:
Flexors-extensors. Pain on examination Lateral& medial rotators 3-/5. 1 /5
Abductors-adductors. 3-/5. 1 /5
6. Knee:
Flexors-extensors. 4+/5. 1 /5
7. Ankle:
Dorsi flexors-plantar flexor 4+/5 4+/5
Inversors- eversors. 4+/5 4+/5
8.trunk muscles:
Unable to Roll over bed due to pain over left hip.
Reflexes Rt. Lt.
1.Corneal Present. Present
2. Conjunctival Present. Present
3. Pharyngeal Present. Present
4 Palatal. Present. Present
5.plantar Flexor flexor
6. Biceps 3+ 3+
7 triceps 3+ 3+
8.supinator. 2+ 2+
9. Knee. - -
10. Ankle - -
Cerebellar examination : Normal
Sensory examination : Normal
Spine examination: Tenderness over L-S spine
CVS: S1,S2 hear, no murmurs
RS : BAE+, NVBS heard
P/A:Soft, non tender,a single umbilical hernia of 3*2cm, oval shape is noted .
INVESTIGATIONS
XRAY PELVIS WITH BOTH HIPS
X RAY LEFT FEMUR
LS SPINE AP VIEW
LS SPINE LATERAL VIEW
PROVISIONAL DIAGNOSIS:
LOWER BACKACHE UNDER EVALUATION ? LEFT HIP CHRONIC OSTEOMYELITIS/INFECTIVE ARTHRITIS? LUMBAR DISC DISEASE DM+ SINCE 3 MONTHS.
TREATMENT GIVEN:
1.TAB. GLIMI M1 PO/OD
2. TAB. METFORMIN SR 500 MG /PO/OD
3.GRBS CHARTING 8TH HOURLY
4. INJ. TRAMADOL 1 AMP IN 100ML NS / IV/BD
5. INJ. ZOFER 4MG /IV/OD
ON 21/2/2021.
S: Patient complaints of pain in left hip region.
No fresh complaints
O: Patient is conscious, coherent, cooperative.
Temp: afebrile
PR:76 bpm
RR: 18 cpm
BP:130/80 mm hg.
CVS:S1, S2HEARD ,NO MURMURS
RS: BAE+, NVBS HEARD.
P/A: SOFT, NON TENDER.
A: LOWER BACKACHE UNDER EVALUATION ? LEFT HIP CHRONIC OSTEOMYELITIS/INFECTIVE ARTHRITIS? LUMBAR DISC DISEASE DM+ SINCE 3 MONTHS.
P: 1.TAB. GLIMI M1 PO/OD
2. TAB. METFORMIN SR 500 MG /PO/OD
3.GRBS CHARTING 8TH HOURLY
4. INJ. TRAMADOL 1 AMP IN 100ML NS / IV/BD
5. INJ. ZOFER 4MG /IV/OD
6. INJ. MONOCEF 1 GM/IV/ BD.
On 22/2/2021.
S: Patient is felling better, decreased pain in left hip, no fresh complaints.
O: Patient is conscious, coherent, cooperative.
Temp: afebrile
PR:72 bpm
RR: 19 cpm
BP:130/90 mm hg.
CVS:S1, S2HEARD ,NO MURMURS
RS: BAE+, NVBS HEARD.
P/A: SOFT, NON TENDER.
A: LOWER BACKACHE UNDER EVALUATION ? LEFT HIP CHRONIC OSTEOMYELITIS/INFECTIVE ARTHRITIS? LUMBAR DISC DISEASE DM+ SINCE 3 MONTHS.
P: 1.INJ. TRAMADOL 1 AMP IN 100ML NS / IV/BD
2. INJ. ZOFER 4MG /IV/sos
3. INJ. PAN 40 MG IV /OD
4.. INJ. CEFTRIAXONE 1GM /IV /BD.
5. TAB. GLIMI M1 PO/OD
6. TAB. METFORMIN SR 500 MG /PO/OD
7. Bp and PR CHARTING 8TH HOURLY
On 23/2/2021
S: Patient complaints of pain in left hip region, anterior thigh.
No fresh complaints
O: Patient is conscious, coherent, cooperative.
Temp: afebrile
PR:78 bpm
RR: 20cpm
BP:130/90 mm hg.
CVS:S1, S2HEARD ,NO MURMURS
RS: BAE+, NVBS HEARD.
P/A: SOFT, NON TENDER.
Left side - SLRT+ , TENDERNESS AT LEFT SIJ AND ANTERIOR THIGH REGION.
A: LOWER BACKACHE UNDER EVALUATION ? LEFT HIP CHRONIC OSTEOMYELITIS/INFECTIVE ARTHRITIS? LUMBAR DISC DISEASE DM+ SINCE 3 MONTHS.
P: 1.INJ. TRAMADOL 1 AMP IN 100ML NS / IV/BD
2. INJ. ZOFER 4MG /IV/sos
3. INJ. PAN 40 MG IV /OD
4.. INJ. CEFTRIAXONE 1GM /IV /BD
5. TAB. GLIMI M1 PO/OD
6. TAB. METFORMIN SR 500 MG /PO/OD
7. Bp and PR CHARTING 8TH HOURLY
24/2/2021
S: Patient complaints of pain in left hip region, anterior thigh.
No fresh complaints
O: Patient is conscious, coherent, cooperative.
Temp: afebrile
PR:102 bpm
RR: 20cpm
BP:130/100 mm hg.
CVS:S1, S2HEARD ,NO MURMURS
RS: BAE+, NVBS HEARD.
P/A: SOFT, NON TENDER.
Left side - SLRT+ , TENDERNESS AT LEFT SIJ AND ANTERIOR THIGH REGION.
A: LOWER BACKACHE UNDER EVALUATION ? LEFT HIP CHRONIC OSTEOMYELITIS , DM+ SINCE 3 MONTHS.
P: 1.INJ. TRAMADOL 1 AMP IN 100ML NS / IV/BD
2. INJ. ZOFER 4MG /IV/sos
3. INJ. PAN 40 MG IV /OD
4.. INJ. CEFTRIAXONE 1GM /IV /BD
5. TAB. GLIMI M1 PO/OD
6. TAB. METFORMIN SR 500 MG /PO/OD
7. Bp and PR CHARTING 8TH HOURLY
Patient shifted to orthopedic department for further management of CHRONIC OSTEOMYELITIS OF HIP.
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