1801006008-SHORT CASE
A 14 YEAR OLD GIRL WITH PAIN IN THE LOWER LIMBS AND LOWER BACK PAIN SINCE 3 DAYS
HOPI
She is second born child of parents married of 3rd degree consanguinity in 2009. All trimesters were uneventful. She was delivered through Caeserean section because of delayed labour pain with birth weight of 3kg.
2012
She was asymmtomatic upto age of 3 years, then she developed high grade fever with cough and vomittings. She was diagnosed with Sickle cell anaemia. Sickling test positive and Electrophoresis showed HbS. Blood transfusion were given 1packet.
2013
She developed high grade fever, dry cough and cold. She was diagnosed with Bronchopneumonia. X-ray lower lobe consolidation.
2015
She had recurrent episodes of fever, cough , cold i.e Recurrent Bronchopneumonia- 6 episodes in 3years. Urine culture showed Klebsiella growth.
Blood transfusion till date 4 times.
2016
She developed fever, pain abdomen , myalgia and arthralgia. She improved on medications and thus was discharged.
2019
She came with stomach pain and vomittings. She was diagnosed to have Acute pancreatitis.
2022
She developed stomach which was sudden in onset, gradually progressive, pricking type in epigastrium,aggravates on walking.
She had 2episodes of vomitting- watery, non bilious, projectile. Dark coloured stools and dark urine.
No history of constipation, difficulty in swallowing, burning sensation.
Was managed conservatively and sent home with Medication
She is immunized till date.
2023
Patient complains of pain in both the lower limbs in her muscles since 3 days along with a stabbing type of back pain near her tailbone. No aggravating or releiving factors , no history of fever or abdominal pain
PAST HISTORY
Known case of Sickle cell Anemia.
History of Bronchopneumonia.
History of 8 PICU admissions.
Previous blood transfusions.
No history of Asthma, Thyroid Tuberculosis, Hypertension, Diabetes, Epilepsy
Personal history
Diet: mixed
Appetite: normal
Sleep: adequate
Bowel and bladder movements regular
No addictions
FAMILY HISTORY
Pedigree chart
3rd degree consanguity of parents
No known affected relatives
GENERAL EXAMINATION:
Patient was conscious, coherent and cooperative. Well oriented to time, place and person.
Pallor present
Icterus absent
Cyanosis, clubbing, lymphadenopathy, Pedal edema absent
Vitals
Temp: Afebrile
PR- 96Min
RR- 18/Min
BP- 110/70 mmHg
SYSTEMIC EXAMINATION
P/A - Shape of abdomen- Normal. Umbilicus everted. No scars. No organomegaly. Bowel sounds heard.
CVS- S1 S2 heard, no murmurs
RS- NVBS.
CNS- NFND
Tone, power and reflexes are normal.
On examination on lower limbs bilateral calf tenderness is seen.
INVESTIGATIONS
( Done previously at our hospital to confirm diagnosis of sickle cell anemia)
Diagnosis
1. Vasocclusive crisis of sickle cell anemia
2.osteomyelitis / osteonecrosis secondary to sickle cell anemia
CURRENT MANAGEMENT ( mainly pain management)
1. Naproxen 250 mg
2.diclofenac
LITERATURE
Comments
Post a Comment