Case for Oct 2013

Case Discussion: October 2013

Mr SS, a 34- yr-old male presented to our OPD with a history of polyarthritis involving small and large joints for past 4 years.  Ankle was the first joint involved followed by feet, bilateral knees, and hip. From the past 6 months, the patient was experiencing pain and stiffness in both the elbows and was unable to sit and squat. Although, the stiffness was not significant, it persisted for 2 -3 hours in early mornings. The patient also reported the occurrence of less severe backache from past 6 months and loss of 15 kg weight within 1 year. He had enthesitis of bilateral Achilles from past 4 years. Physical examination revealed:  swelling in ankles and knees, tenderness of elbows with minimal swelling, and hip pain on lateral rotation. Spine examination showed minimal restriction in low back movement. The flexibility evaluated through Shober's modified was 5 cms. There was minimal swelling in heel. Other system examinations were normal. The findings of clinical and lab findings are given in table 1 and 2.

Table 1: Results of investigations done prior to the visit to our OPD

Date

04/10/2011

07/08/2011

Hb

12.7

---

TC

14900

---

N

76

---

L

16

---

E

5

---

M

3

---

ESR

35

112

PLT

5.58

---

Urine routine

Alb (+)

---

RF

negative

---

 

Table 2: Results of investigations done in our OPD

CLINICAL PARAMETERS

08/10/2012

HEMOGLOBIN

12.3

TOTAL WBC COUNT

10440

NEUTROPHILS

69.6

BASOPHILS

0.5

LYMPHOCYTES

21.7

EOSINOPHILS

0.5

MONOCYTES

7.7

ESR(Westergren's method)

98

PLATELET COUNT

6.18

RBC COUNT

4.6

RANDOM BLOOD SUGAR

84

S.G.O.T [A.S.T ]

19

S.G.P.T [A.L.T ]

39

CREATININE (Kinetic Jaffe)

0.7

C-REACTIVE PROTEIN (QUANTATIVE IMMUNOTURBIDIMETRIC METHOD)

32.55

ANA IMMUNO-FLUORESCENCE (1:40 dilution)

NEGATIVE

RHEUMATOID FACTOR ASSAY (QUANTITATIVE IMMUNOTURBIDIMETRY)

<6.7

HUMAN IMMUNO DEFICIENCY VIRUS 1and2 (RAPID)

NON REACTIVE

HEPATITIS B SURFACE ANTIGEN-HBsAG(RAPID)

NON REACTIVE

HEPATITIS'C'VIRUS ANTIBODY (RAPID)

NON REACTIVE

TOTAL BILIRUBIN (Modified Jendrassik)

0.2

DIRECT BILIRUBIN (Modified Jendrassik)

0.1

INDIRECT BILIRUBIN

0.1

ALKALINE PHOSPHATASE (Kinetic)

77

GAMMA GT

30

TOTAL PROTEIN

7.7

SERUM ALBUMIN

3.6

GLOBULIN

4.1

AG RATIO

0.8

COLOUR

Pale Yellow

APPEARANCE

Clear

EPITHELIAL CELLS

2-4/HPF

CASTS

Absent

CRYSTALS

Absent

HAEMATOCRIT(PCV)

38.9

M.C.V

84.2

MCH

26.6

MCHC

31.6

RDW

15.7

REACTION

6

SPECIFIC GRAVITY

1.03

PROTEIN

Negative

SUGAR

Negative

KETONE BODIES

Negative

BILE SALT

Negative

BILEPIGMENT

Negative

NIT

Negative

LEUCOCYTES

2-4/HPF

RBCs

Absent

 

Discussion of the case