DRUG INDUCED HEPATITIS SECONDARY TO BORDERLINE LEPROMATOUS LEPROSY DAPSONE SYNDROME

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"This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment"

31 year old male who is a photographer by occupation came to the casuality with complaints of Yellowish discolouration of sclera since 4 days ,Fever since 2 days  which is  insidious on onset , gradually progressive , subsided on medication. C/o Nausea and vomitings since 2 days Non -bilious and non projectile , food particle as content and was taken to local hospital in view of vomitings . 


Patient was apparently asymptomatic 17 years back then his mom observed hypopigmented patch over the cheek , and multiple hypopigmentation patches areas all over the body , neglected thinking it was due to vitamin deficiency , 15 days back mother observed a hypopigmented patch on the right arm and took him to a local hospital and was diagnosed with hansens and was on treatment since then.
No complaints of shortness of breath, palpitations , headache , orthopnea, PND . 

Non - Alcoholic 
Non - Smoker 

On examination 
Patient is conscious coherent co operative 
Oriented for time place and person 
Pallor ++
Icterus ++
No cyanosis 
Clubbing or lymphadenopathy 
Febrile : 99.9 
Bp: 130/80mmhg 
PR: 83 bpm regular normal volume 
CVS : s1s2 no murmurs 
Rs : NVBS + no crepts 
P/A: mild splenomegaly + BS + 
CNS : 
Tone :   Rt            Lt 
  UL       N              N 
  LL        N              N 

Power :  Rt            Lt 
    UL       5/5          5/5 
    LL        5/5           5/5

Reflexes : 

                B      S      T      A    K      P
Rt.           2+  2+   2+    2+    2+   F
Lt           2+  2+    2+  2+     2+    F

Sensory : 
Fine touch : present 
Crude touch : present 
Lost sensation over the hypopigmented lesion on lower limbs
Intact sensation over the lesions on forearm & neck 
(Touch , pain & temperature were intact over forearm & neck lesions

Lost pain & touch over lower limb lesions)

Diagnosis : 
?Wilson’s disease with Hansen’s 
?DRUG INDUCED HEPATITIS

Treatment given:
1.TAB.UDILIV 300 MG/PO/BD
2.TAB.RIFAXIMINE 550 MG/PO/BD
3.SYP.LACTULOSE 10ML/PO/TID
4.INJ.PANTOP 40 MG/IV/OD
5.INJ.ZOFER 4MG/IV/SOS
6.IVF NS AND RL @50 ML WITH 1 AMP OF OPTINEURON IV/OD
7.MONITOR VITALS 2ND HRLY

DOA: 26/04/22
SOAP NOTES AMC DAY 1:

S 
Yellowish discoloration of sclera  since 4 days 
 Fever since 2 days


O
GENERAL EXAMINATION:
Patient is  conscious,coherent, co operative 
Oriented to time ,Place, Person 
VITALS :
Temp 98.6 F
BP: 120/80mm hg
PR: 95bpm
RR: 17cpm

PER ABDOMEN EXAMINATION:
Mild Splenomegaly+
Bowel sounds present 

CARDIOVASCULAR SYSTEM:
S1, S2 heard

RESPIRATORY SYSTEM:
BAE present, NVBS 

CNS :NAD 

Hb- 10.6
Urine bile salts and bile pigments positive
LDH 868 IU/L
Total bilirubin 7.82
Direct bilirubin 5.63
AST 401
ALT 580
ALP 208

A
DIAGNOSIS :
?WILSON'S DISEASE WITH HANSENS 
? DRUG INDUCED HEPATITIS

P
1.TAB.UDILIV 300 MG/PO/BD
2.TAB.RIFAXIMINE 550 MG/PO/BD
3.SYP.LACTULOSE 10ML/PO/TID
4.INJ.PANTOP 40 MG/IV/OD
5.INJ.ZOFER 4MG/IV/SOS
6.IVF NS AND RL @50 ML WITH 1 AMP OF OPTINEURON IV/OD
7.MONITOR VITALS 2ND HRLY


SOAP NOTES AMC DAY 2:

S 
Yellowish discoloration of sclera+ 
 No fresh complaints


O
GENERAL EXAMINATION:
Patient is  conscious,coherent, co operative 
Oriented to time ,Place, Person 
VITALS :
Temp 98.4 F
BP: 110/80mm hg
PR: 90bpm
RR: 18cpm

PER ABDOMEN EXAMINATION:
Mild Splenomegaly+
Bowel sounds present 

CARDIOVASCULAR SYSTEM:
S1, S2 heard

RESPIRATORY SYSTEM:
BAE present, NVBS 

CNS :NAD 

DVL referral: BORDERLINE LEPROMATOUS LEPROSY
Ophthal referral: B/L Heterochromia iridis
Direct Coombs test Negative
USG: No sonological abnormality detected
Today LFT(28/04/22)

MADDREYS DISCRIMINATORY SCORE: 21.3

A
DIAGNOSIS :
DRUG INDUCED HEPATITIS SECONDARY TO BORDERLINE LEPROMATOUS LEPROSY

P
1.NORMAL DIET
2.TAB.UDILIV 300 MG/PO/BD
3.SYP.LACTULOSE 10ML/PO/TID
4.INJ.PANTOP 40 MG/IV/OD
5.INJ.ZOFER 4MG/IV/SOS
6.IVF NS AND RL @50 ML WITH 1 AMP OF OPTINEURON IV/OD
7.SYP.HEPAMERZ 10 ML/PO/TID
8.FUDIC CREAM L/A
9.MONITOR VITALS 2ND HRLY
10.INJ.VIT K 1 AMP IN 100ML NS

SOAP NOTES AMC DAY 3:

S 
Yellowish discoloration of sclera+ 
 No fresh complaints


O
GENERAL EXAMINATION:
Patient is  conscious,coherent, co operative 
Oriented to time ,Place, Person 
VITALS :
Temp 98.4 F
BP: 110/80mm hg
PR: 86bpm
RR: 16cpm

PER ABDOMEN EXAMINATION:
Mild Splenomegaly+
Bowel sounds present 

CARDIOVASCULAR SYSTEM:
S1, S2 heard

RESPIRATORY SYSTEM:
BAE present, NVBS 

CNS :NAD 

On 29/04/2022:
Slit skin smear and skin biopsy done


MADDREYS DISCRIMINATORY SCORE: 21.3

A
DIAGNOSIS :
DRUG INDUCED HEPATITIS SECONDARY TO BORDERLINE LEPROMATOUS LEPROSY
DAPSONE SYNDROME

P
1.NORMAL DIET
2.TAB.UDILIV 300 MG/PO/BD
3.SYP.LACTULOSE 10ML/PO/TID
4.INJ.PANTOP 40 MG/IV/OD
5.INJ.ZOFER 4MG/IV/SOS
6.IVF NS AND RL @50 ML WITH 1 AMP OF OPTINEURON IV/OD
7.SYP.HEPAMERZ 10 ML/PO/TID
8.FUDIC CREAM L/A
9.MONITOR VITALS 2ND HRLY
10.INJ.VIT K 1 AMP IN 100ML NS
11.Tab.Omnacortil 20mg OD/PO after mrng breakfast.
12 .Tab.Omnacortil 5 mg OD/PO after dinner.

1/05/22
SOAP NOTES AMC BED -2
S -
Yellowish discoloration of sclera +
No fresh complaints
O- Patient is consious, co-herent, co-operative
No icterus,odema,cyanosis, clubbing, lymphadenopathy.
VITALS :
Temperature - 98.1F
Pulse rate - 84BPM, REGULAR, NORMAL VOLUME
BP -
@8AM-120/70MM OF HG
SPo2 - 98%@RA
SYSTEMIC/ EXAMINATION - 
CVS -S1,S2 Heard
RS-BAE+
CNS-NAD
P/A-Mild Splenomegaly+
Bowel sounds present 

A
DIAGNOSIS-
 DRUG INDUCED HEPATITIS
?BORDERLINE LEPROMATOUS LEPROSY 
P-
1.IVF NS @75ML /HR WITH 1 AMP OF OPTINEURON IV/OD
2.INJ VIT K 1 AMP IN 100ML NS/IV/OD
3.TAB.UDILIV 300 MG/PO/BD
4.TAB OMNICORTIL 20MG PO/OD O-×
TAB OMNICORTIL 5MG PO/OD X-O
5.TAB ANTOXID PO/OD 2PM
6.TAB HEPTAGON PO/OD 2PM
7.SYP.LACTULOSE 10ML/PO/TID
8.FUDIC CREAM L/A


2/05/22

SOAP NOTES AMC BED -2
S -Yellowish discoloration of sclera +
No fresh complaints
O- Patient is consious, co-herent, co-operative,
No icterus,odema,Q cyanosis, clubbing, lymphadenopathy.
VITALS :
Temperature - 99.4F
Pulse rate - 78BPM, REGULAR, NORMAL VOLUME
BP -@8AM-120/80MM OF HG
SPo2 - 98%@RA
SYSTEMIC/ EXAMINATION - 
CVS -S1,S2 Heard
RS-BAE+
CNS-NAD
P/A-Mild Splenomegaly+
Bowel sounds present 

A
DIAGNOSIS-
DRUG INDUCED HEPATITIS
?BORDERLINE LEPROMATOUS LEPROSY 

P-
1.IVF NS @75ML /HR WITH 1 AMP OF OPTINEURON IV/OD
2.INJ VIT K 1 AMP IN 100ML NS/IV/OD
3.TAB.UDILIV 300 MG/PO/BD
4.TAB OMNICORTIL 20MG PO/OD O-×
TAB OMNICORTIL 5MG PO/OD O-O
5.TAB ANTOXID PO/OD 2PM
6.TAB HEPTAGON PO/OD 2PM
7.SYP.LACTULOSE 10ML/PO/TID
8.FUDIC CREAM L/A

SOAP NOTES AMC BED -2 3/05/22
S -yellowish discoloration of sclera +
No fresh complaints
O- Patient is consious, co-herent, co-operative,
No icterus,odema, cyanosis, clubbing, lymphadenopathy.

VITALS :
Temperature - 98.6F
Pulse rate - 82BPM, REGULAR, NORMAL VOLUME
BP -@8AM-120/80MM OF HG
SPo2 - 98%@RA
SYSTEMIC/ EXAMINATION - 
CVS -S1,S2 Heard
RS-BAE+
CNS-NAD
P/A-Mild Splenomegaly+
Bowel sounds present 

A
DIAGNOSIS-
 DRUG INDUCED HEPATITIS
? HANSENS DISEASE
P-
1.IVF NS @75ML /HR WITH 1 AMP OF OPTINEURON IV/OD
2.INJ VIT K 1 AMP IN 100ML NS/IV/OD D5
3.TAB.UDILIV 300 MG/PO/BD
4.TAB ANTOXID PO/OD 2PM
5.TAB HEPTAGON PO/OD 2PM
6.SYP.LACTULOSE 10ML/PO/TID
7.FUDIC CREAM L/A

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