35 yr old with low backache .
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A 33YEARS OLD MALE PATIENT WHO IS AN VEGETABLES VENDOR CAME WITH C/O LOW BACKACHE SINCE 1 1/2 YEAR AND C/O EXCESS SWEATING DURING SLEEP SINCE 3 YEARS .
HISTORY OF PRESENTING ILLNESS:
IN 2009 PATIENT HAD AN SUSTAINED INJURY TO RIGHT KNEE JOINT LIGAMENT TEAR WHILE PLAYING FOOTBALL FOR WHICH ABOVE KNEE CAST WAS DONE .IN 2020 PATIENT HAD INJURY TO RIGHT FOOT (TARSAL BONE #) WHILE JUMPING ,PATIENT WAS KEPT ON CAST IMMOBILIZATION FOR 1MONTH.SINCE 3YEARS PATIENT IS HAVING EXCESS SWEATING WHILE SLEEPING (IN BOTH HOT AND COLD WEATHER) ,SWEATING NOT ASSOCIATED WITH CHEST PAIN AND SOB.SINCE 1 1/2 YEAR PATIENT IS HAVING DULL LOW BACKACHE RADIATING TO RIGHT LEG ,AGGREVATES ON BENDING ,RELIEVES WHILE LYING DOWN . PATIENT VISITED TO HOMEOPATHY DOCTOR FOR BACKACHE AND USED MEDICATION FOR PAIN FOR 1YEAR AND STOPPED 1MONTH BACK.LAST MONTH HE WENT TO ORTHOPEDIC DOCTOR ?EARLY DEGENERATIVE CHANGES IN L3L4L5 VERTEBRAE WAS NOTED BY ORTHOPEDIC SURGEON.
PAST HISTORY : NOT A K/C/O DM /HTN/CAD/TB/ASTHMA
PERSONAL HISTORY :
DIET MIXED
APPETITE NORMAL
BOWEL NORMAL
MICTURITION NORMAL
ALCOHOL OCCASIONAL AND NON SMOKER
FAMILY HISTORY : NOT SIGNIFICANT GENERAL EXAMINATION :
NO PALLOR
NO ICTERUS
NO CYANOSIS
NO LYMPHADENOPATHY
NO EDEMA OF FEET
VITALS
BP 120/70 MMHG
PR 78 BPM
RR 16 CPM
SPO2 96% AT ROOM AIR.
LOCAL EXAMINATION OF SPINE:
INSPECTION:
STRETCH MARKS PRESENT OVER POSTERIOR LUMBAR AREA.
NO MUSCLE WASTING SEEN.
NO ASYMMETRY OF SPINE.
NO HIP GIRDLE TILT PRESENT.
PALPATION:
ON PALPATION TENDERNESS PRESENT OVER POSTERIOR LUMBAR AREA.
ALIGNMENT OF SPINAL PROCESSES NORMAL.
SPECIAL TESTS:
MODIFIED SCHOBERS TEST
1.BEFORE EXTENSION 15CMS AFTER EXTENSION 24CMS
2.CHEST EXPANSION
a) EXPIRATION 100.5 CMS
b)AFTER DEEP INSPIRATION 104CMS.
PROVISIONAL DIAGNOSIS:
SPONDYLO ARTHROPATHY
TREATMENT:
1.TAB.INDOCAP SR 75MG PO/OD.
2.TAB.MVT PO/OD.
COURSE IN HOSPITAL : PATIENT CAME WITH C/O LOW BACKACHE AND EXCESS SWEATING ,PATIENT WAS ADMITTED AND INVESTIGATIONS WERE DONE. MODIFIED SCHOBERS TEST WAS DONE WHICH SHOWED 1.BEFORE EXTENSION 15CMS AFTER 24CMS 2.CHEST EXPANSION a) EXPIRATION 100.5 CMS b)AFTER DEEP INSPIRATION 104CMS. AFTER 2DAYS PATIENT C/O ITCHY SKIN LESIONS BETWEEN 4TH AND 5TH FINGERS OF LEFT FOOT SINCE 2YEARS ,FOR WHICH DERMATOLOGY REVIEW WAS TAKEN AND DIAGNOSIS OF INTERTRIGO (CANDIDA) WAS DONE AND MEDICATIONS WERE PRESCRIBED FOR THE SAME .PATIENT WAS HAEMODYNAMICAL STABLE WHILE DISCHARGE.
FINAL DIAGNOSIS :
SPONDYLO ARTHROPATHY.
INTERTRIGO (CANDIDA) WITH
LOCALISED HYPERHYDROSIS.
ADVICE AT DISCHARGE:
1.TAB.INDOCAP 75MG PO/OD.
2.CLOTRIMAZOLE 1% CREAM LOCAL APPLICATION MORNING AND NIGHT.
3.TAB.FLUCANAZOLE 150MG PO/WEEKLY TWICE FOR 2WEEKS
4.TAB. TECZINE 5MG PO/SOS.