Particulars of the Patient

Name: Mr MD Shohel
Age: 28 years
Sex: male
Address: Bandarban
Date of Admission: 10 May 2024
 Chief Complains
• Fever for 2 months
• Vomiting for 1.5 months
• Weight loss since 1 month
• Skin lesions since 2 months
 History of Present illness
According to the patient's statement, he was
reasonably well 3 month back. Then he developed
high grade fever for 2 months (highest recorded
temperature 104°F which was accompanied by chills
and night sweats . It subside after taking
paracetamol.
He also complains of Vomiting for 1.5 months that
started after taking alternative medicine, non
projectile, weight loss since 1 month from 64kg to
46kg and multiple skin rashes since 2 months .
He also complains of skin lesions. He comments he noticed a single coin
shaped lesion on the right cheek 7 years back . Then he noticed multiple
lesions beginning to appear 2 months back which was aggravated after
he took alternative medicine 1.5 months back.
It appeared first in the right cheek quickly spreading to his full face , ear
and head ,truck, arms and things.
The skin lesions are aggravated on exposure to sunlight.
He also says he lost weight since 1 month from 64 kg to 46 kg.
There is no H/o oral ulcers, no H/o fatigue ,no H/o joint pains/
stiffness/swelling, no h/o discoloration of fingers
upon exposure to cold, no H/o shortness of breath/
chest pain/headache/confusion or memory loss .
No H/o dysphagia/tightening of skin/dry eyes/dry
mouth/proximal muscle weakness, no H/o high
colored urine/hematuria or abdominal pain.
 General Examination
Appearance: Ill –looking Bony tenderness, Pigmentation: Absent
Body Built: thim Thyroid Gland: Not enlarged
Co-operation: Co-operative Lymph Node: Not palpable.
Anemia: Absent
Jaundice: Absent Pulse: 92 bpm
Edema: absent Blood pressure : 100/60 mmHg
Clubbing: absent Temp: 98°F
Koilonychia: Absent
Leukonychia: Absent
Normal bowel and bladder habits.
On Examination cont.
Cutaneous examination showed multiple, well
defined, erythematous plaques ranging in size from
2-15cm with adherent scales and hyperpigmented
borders, distributed bilaterally on face
including bridge of nose, cheeks, head, ear. It is also present in the
trunk, both arms and thighs
He also have alopecia
Gastrointestinal System Examination
Eyes and conjuctiva : normal

Lips, gum, teeth – normal

oral cavity – fungal infection present

On palpation,

There is no superficial tenderness & local rise of temperature.

On deep palpation there is no epigastric tenderness, Liver is not enlarged

Spleen is not palpable

Kidneys are not ballotable

Cont.
On percussion ,
tympanic sound, shifting dullness is absent

On auscultation,
Bowel sound normal.

Cardiovascular Examination
No abnormality detected
Respiratory Examination
Inspection:
Movement and shape of the chest is normal.
Palpation:
• Trachea is Centrally Placed.
• Chest expansion is bilaterally symmetrical
Percussion:
percussion note is resonant.
Auscultation:
• Breath Sound – vesicular
• Vocal resonance - normal
• No added sound.

Other System reveals no abnormality.

Musculoskeletal system
Both knee and ankle joints have no redness, no deformity, no swelling
or pain
Wrist, metacarpophalangeal , interphalangeal joints of both hands have
no abnormality

Cardiovascular system and nervous

system
No abnormality detected
On the basis of history & clinical examination my provisional
diagnosis is

Discoid lupus erythematosus with candida infection

Differential Diagnosis:
Cutaneous TB
Investigation profile

Hb – 10.5 g/dL
ESR – 72 mm
RBC 3.67 /cumm
WBC - 5500 /cmm
Platelet - 150,000 /cumm
CRP 3.08 mg/l
RA/RF 8.69 IU/ml
ANA 272
Anti DsDNA 9.81 IU/ml
vDRL negative
TPHA negative
Albumin +
 Thank You
Case presented by
Dr. Sadia Akter