Shree clinic, Rheumatology centre is a unique one of its kind hospital in India dedicated for management of patients suffering from musculoskeletal disease (rheumatology) and other immunological diseaset.
- 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