Rheumatology


        

Case Discussion

AUTO IMMUNE DIESEASE   Posted By nitin kumar mudgal    Date : 17-Aug-08   01:18 AM     Reply

Dear Doctor,

My mother is suffering from an illness which is still not diagnosed. We are taking treatment from last 18 months but all in vain. She is aged about 48 yrs. Now she is on ventilator support and admitted to Bhopal Memorial Hospital & Research Center, Bhopal. In these circumstances we are unable to move with her for consultation. Doctors are still unable to find out the disease but they suspect some kind of immunological problem. Sir/Madam I request you to help me to save my mother's life.

Present symptoms are as under:-

1. Steep reduction in Hemoglobin despite blood infusions.

2. High fever after blood infusion with continuous hallucinations and seizures.

3. Semi consciousness

4. Acute weakness despite rich protein and vitamin diet.

I am sending you a brief history of her prolonged illness and information sheet of tests with findings. The detail is as under :-

Doctor, My mother has been a thyroid patient for last 4 years. In the month of march-2007 (around 16 months before) she felt acute weakness with black motion. The doctor diagnosed ulcers in esophagus and prescribed treatment, she recovered from ulcers but loose motion, vomiting and lose of appetite continued over the period. We again consulted the doctor and he prescribed antibacterial drug (forcox). After which demilation of optic nerve occurred. Subsequently she complained about severe headache and continuous nerve movement in head. Loss of appetite, weakness, improper body movement and vibration in body movement, shamble walk are the other symptoms after that.

The physician we have consulted at that time, diagnosed possibility of autoimmune disease and connective tissue disorder. But no line of treatment only steroids were given . That was of no help.

I am also attaching various reports during the period. And latest lab reports also in the attachment.

Your immediate help is required and if you prescribe some medicines I will be highly thankful to you.

Waiting for your early reply.

Attachment:-

Summery of medical test reports (Mrs. Kusum Lata Mudgal) Sl. No. name of test date findings 1 Serum Calcium 30.03.2006 7.4 2 TSH 15.01.2007 2.82 3 free t4 15.01.2007 1.19 4 Blood Test 13.01.2007 heamoglobin - 11.8, RBC- 3.20, WBC - 7850 5 Endoscopy 10.04.2007 Esophagus - GE junction at 36 cm. Severe heyperemia with multiple linear deep erosions with few deep ulcer at the lower end.) Stomach - fundus - normal mucosa. Body - mucosa is hyperemic with multiple superficeal erosions and submucosal haemorrhagic patches predominantly along the greater curvature. 6 Blood Test 10.04.2007 heamoglobin - 10.2, WBC - 9700 7 Urine R/M 27.04.2007 Albumin - Nil 8 s. Protien 27.04.2007 Total Protein - 5.50, Albumin - 3.37, Globulin - 2.13 9 Blood Test 27.04.2007 haemoglobin - 10.8 10 Tissue Transglutaninase 24.05.2007 1.2 11 blood test 18.06.2007 haemoglobin - 8.9, SGOT - 47, PROTIEN - 5.3, ALBUMIN - 3.2 12 STOOL EXAMIN 30.06.2007 OCCULT BLOOD - POSITIVE 13 HIV 1 & HIV 2 29.06.2007 NEGATIVE 14 DUODENAL BIOPSY 30.06.2007 1). Chronic duodenitis. No evidence of MAS/HMS. 15 OESOPHAGO - GASTRO DUDENOSCOPY REPORT 29.06.2007 Early barreet oesophagus hiatus hernia. Biopsy taken from 2nd part duodenum to rule out malabsorption syndrome 16 ULTRASOUND 02.07.2007 MILD CHANGES OF FATTY INFILTRATION LIVER 17 colonoscopy report 02.07.2007 Normal 18 Enteroclysis Report 11.07.2007 Normal Study of small gut morphology with strong probability of small gut dysmotility. 19 CT THORAX CONTRAST 13.08.2007 No Significant abnormality 20 CT SCAN WHOLE ABDOMIN CONTRAST 13.08.2007 findings suggest hepatomegaly. Right ovarian cyst may be physiological. 21 Blood Test 13.08.2007 heamoglobin - 6.80, mcv 102 22 LIVER PANEL 1 (LFT) 13.08.2007 SGOT - 63, GGTP - 33, PROTIEN - 5.30, ALBUMIN - 3.20 23 serum ferritin 05.09.2007 409.5 ng/ml 24 Blood Test 08.10.2007 haemoglobin - 10.5 25 Blood Test 20.10.2007 haemoglobin - 9.2, Total protein - 5.34, Globulin - 1.92, Serum A/G ratio - 1.78 26 NCCt Head 17.10.2007 Cerebral and cerebellar atrophic changes 27 Vitamin B12 04.11.2007 H>2000 28 Bone Marrow Examination 13.11.2007 Megaloblastic Anaemia 29 Blood Test 14.11.2007 Haemoglobin - 8.4 30 MRI Scan of Brain 19.11.2007 Minimal diffuse cerebellar and cerebral atrophy. Mild degenerative changes in cervical vertebral column. 31 Erythrocyte Sedimentation Rate 08.02.2008 E.S.R - 31 32 Serum Calcium & Serum Creatinine 08.02.2008 Serum Calcium - 8.60, Serum Creatinine - 1.70 33 Anti Nuclear Antibody Profile 09.02.2008 ss - B Antibodies : Intermediate Positive, SS -A Antibodies : Intermediate Positive. 34 Routine urine analysis 09.02.2008 Albumin - + 35 MRI Scan of Brain 09.02.2008 No significant positive findings, except for mild cerebral/cerebellar atrophy. 36 USG Upper Abdomen 08.02.2008 Bilateral Kidneys are borderline small in size, however normal in position, No evidence of calculus or hydronephrosis.. Echogenicity of both kidneys is increased with indistinct corticomedullary differentiation. 37 Spot Albumin 20.02.2008 10 gm/dl 38 Thyroid profile 23.02.2008 T 3 - 0.75 pg/ml, TSH - 0.27 pg/ml 39 28.02.2008 Blood Urea - 24.5, Serum Creatinine - 1.5 40 ANA Screen 28.02.2008 negetive 41 Blood urea 03.03.2008 Albumin +1 42 Urine exzmination 07.04.2008 protein - 4.78, Albumin -3.00 reports of global hospital 43 haemoglobin 09.07.2008 11.8gm 44 wbc total 4300 45 neutrophil 67% 46 lymphocytes 28% 47 monocytes 0.30% 48 eosinophil 0.20% 49 basophil 0 50 haematocrit 33.90% 51 rbc count 4.31 52 mcv 78.6 53 mch 27.3 54 mchc 34.8 55 rdw-cv 19.1 56 platelet count 1.11 lcs/cum 57 serum urea 15 58 serum creatinin 1.7mg 59 serum sodium 135.0 mmol/l 60 serum potamin 3.26 mm0l/l 61 total bilirubin 0.7mg% 62 bilirubin- direct 0.2 mg% 63 bilirubin- indirect 0.5 mg% 64 sgpt 46.0 iu/l 65 sgot 117.0 iu/l 66 alkaline phosphate 187.0 iu/l 67 total protein 5.2 68 albumin 2.3 69 globulin 2.9 70 a/g ratio 0.79 71 CSF ANALYSIS quantity 2ml colour watery appearance celar coagula not seen blood absent proteins 16.5 mg pandey's test negative sugar 68.2mg cells 5monouclear cells impression appears normal csf 72 adenosine deaminase activity csf 15.0 u/l 73 anti hcv negative 74 usg abd 09.07.08 revealed mild hepatomegaly with coarse echopattern withminimal right pleural effusion with few gas filled bowel loops 75 ANA profile 27.07.2008 negetive yours faithfully,-

amit kumar mudgal L I G - 74, Harshwardhan Nagar, Bhopal, M.P mo. 9424419427.

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Replies to the above case discussion :

Re : AUTO IMMUNE DIESEASE - reena sharma 18-Aug-08    03:50 AM




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