40F DM2 13 yrs, Lt.Plantar foot ulcer, Cellulitis Telangana PaJR

 

01-01-2026

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

[4.19 pm, 01/01/2026] PPM 1: Handwritten notes.

[4.19 pm, 01/01/2026] PPM 1: Clinical images

[4.20 pm, 01/01/2026] PPM 1: Abdominal adiposity and sarcopenia

[4:21 pm, 01/01/2026] PPM 1: 👆@PPM3 How do we explain her Hyponatremia during presentation?

[4:26 pm, 01/01/2026] PPM 3: can it be due to Dehydration sir

[4:34 pm, 01/01/2026] PPM 1: Yes I was told by @PPM4 that even DKA was suspected at the time of admission

[4:35 pm, 01/01/2026] PPM 3: Yes sir

[4:35 pm, 01/01/2026] PPM 3: Urine for ketone bodies was positive sir with metabolic acidosis.

[4:36 pm, 01/01/2026] PPM 1: And metabolic acidosis couldn't be explained by her renal failure?

Any treatment chart image of her iv insulin hourly during admission?

[4:37 pm, 01/01/2026] PPM 3: I will share sir. At admission it was 374 mg/dl.

Narketpally syn CBBLE: Participatory medical cognition Web 2.0-3.0 (January 2026)

 

January 1st, 2026

[8.54 am 01/01/2026] cm: 14 year old girl with multiple DH admissions for the last 2-3 years for fever and recurrent and chronic ulcers over the body for 6-7 months. Ulcers are located over the back, knees, buttock and elbow (bilaterally). She had contractures in b/l knee joint with some swelling but no tenderness/redness, had severe undernutrition and is bed bound. her DH report showed some increased LFTs. She was labelled as SLE and started on steroids in DH. Her steroids were stopped as she developed severe sepsis due to bed sore and the cause was not identified so we stopped medicines to see the symptom evolution. She came last week and had new skin lesions over left shoulder and pain and swelling over shoulder and ankle joint.

Hb 9 g/dl, TLC 9980, DLC-P90, L8, M2, Creatinine 0.4, SGOT/PT42/63, Serum protein/albumin- 6.6/2.9, CRP2.39 mg/dl, ANA, ANCA, anti CCP- negative, viral markers- negative, Thyroid function test- Normal, CXR- Normal

[8.54 am, 01/01/2026] cm: Looks like lupus vasculitis.

The prevalence of ANA-negative SLE is very low, but it exists, particularly under the influence of prolonged use of glucocorticoids or immunosuppressants.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9985371/

Sharing one of our patients of lupus cutaneous vasculitis below:

http://nrakshithareddyrollno106.blogspot.com/2023/10/25f-with-fever-since-3-months.html

https://asjad24.blogspot.com/2023/10/a-case-of-25f-presented-with-fever-and.html

https://youtu.be/O3gLw_UuEoM?si=8z-xgKd50qkMxixf