43 year old female with limited systemic sclerosis

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 box is welcome."

43 year old female,who is apparently normal till 18 years of age.At 18 years of age, patient got married and had gave birth to make child after 1 year .This child expired at 4 months of age due to fever in outside hospital. After 6 months she conceived again and gave birth to female child .The child died at 3 months of age due to fever.Both of this pregnancies ,she had no complications during her pregnancy and delievered by normal vaginal delivery.

After 1 year ,she conceived again and gave birth to male child ( pregnancy was uneventful and child was normal after birth).After 1 and 1/2 year ,she gave birth to one more male child ,at that time also , pregnancy was uneventful and child was healthy.

She was house wife,used to take care of her children and husband. When her elder son was at 13 years of age , she used to go and sit in their shop near counter ( the shop was behind wine shop, where they used to sell snacks and meat for alcohol drinkers).

Last 9 months back , patient had loss of appetite, associated with Generalized weakness and Dragging type of pain in the both lower limbs.Along with that patient used to experience tingling/ shock like sensation when exposed to cold water. and swelling of the both fingers .And pedal edema , associated 

Shortness of breath on exertional activity and relieved by taking rest.

After 1 month patient visited a PHC doctor were she referred her to NIMS hospital and started on few medications, they were on follow up with Bibinagar AIIMS.

Last 4 months ,along with  dragging type of pain in both lower limbs, patient had weakness in lower limbs and unable to get up from sitting position and it was still present. Along with patient had pain in the small joints of  both hands.

There was a swelling of both fingers along with stiffening insuch a way that she is unable to close her fingers.

No history of difficultyb in swallowing ,diarrhea,vomtings and regurgitation of food.

no history of decreased urine output.

No history of fever, cold and cough

no history of  chestpain and palpitations and profuse sweating.

GENERAL EXAMINATION:

No pallor ,icterus,clubbing,cyanosis,lymphadenopathy.

pedal edema +

SYSTEMIC EXAMINATION:

BP: 120/80

PR;80BPM

CVS:S1S2+

RS; BAE+

P/A: SOFT,NON TENDER.

CLINICAL IMAGES:

Investigations: 

Outside reports 

Diagnosis: Limited Systemic Sclerosis.