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A 17 year old male patient who completed his Inter,goes to wage work occasionally,resident of Mangalpally presented to the opd with the chief complaint of itchy ring lesions & purple striae on abdomen,hands & legs.

History of present illness:

Patient was apparently asymptomatic 8 months back then he developed round lesions on hands & legs.Then he developed purple striae on chest,abdomen,hands & legs which gradually increased in size.Round lesions aggravated on taking meat.Later he noticed facial puffiness & pedal edema.

H/o skin ulcer on abdomen.

No history of cold,cough,nausea,vomiting

No history of hematuria

No history of buring micturition.

No bleeding gums.

History of past illness:

The patient was known case of hypertension & under medication since 6 months.

No a known case of diabetes mellitus,bronchial asthma,epilepsy & tuberculosis.No history of any surgeries.

Personal history:

Mixed diet

Bowel & bladder - Normal

No addictions

Sleep adequate 

Family history:

His father had similar round lesions but only localised to hands.

General Examination:

The patient is conscious,coherent and cooperative.He is well oriented to time,place and person.

No Pallor

No Icterus

No Cyanosis

No Lymphadenopathy 

Pedal Edema present

Temperature  - 97.8 degrees F

Pulse rate - 78 bpm

Respiration Rate - 17/min

Blood pressure- 160/100

SpO2 99% at room air.

Systemic examination:

CVS : No thrills

S1 S2 +

RS- Bilateral air entry + 

per abdomen- soft,non tender,Purple striae,skin ulcer seen

CNS- Conscious,Speech normal.

Provisional diagnosis- ?Cushing’s syndrome 

?Tinea corporis

Investigations :

Complete Urine Examination:

Liver Function Test:

Complete Blood Picture:

Glycated Hemoglobin:

Ultrasound Report:

ECG :

                   

               

                  

Renal Function Tests :

Serum Creatinine-0.7 mg/dl

Blood urea - 27 mg/dl

Serum electrolytes :

Sodium - 144 mEq/L

Potassium - 4.0 mEq/L

Chloride- 98 mEq/L

Treatment:

25/11/2021

Tab.Telma-AM 40/5 mg

Tab.Itraconazole 100mg

Tab Anxit 0.25 mg

Tab.MVT

26/11/2021

Tab.Telma 40/5 mg

Tab.Metformin 500 mg

Tab.Itraconazole 100mg

Tab.Levocitrizine 10mg

27/11/2021

Tab.Telma 40/5 mg

Tab.Atarax 25mg

Tab.Sebifin 250mg

30/12/2021

Tab.Telma 40 mg

Tab.Atarax 25 mg

Tab.Sebifin 250mg

Tab.Shelcal 500mg