29F Diabetes 10 yeas Hypertension 4 months Nephrotic syndrome 2 months CKD PaJR

 

SUNDAY 29 JANUARY 2023

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 THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

Previous links of this case report are given below 👇

https://166sasirakasinadhuni.blogspot.com/2023/01/27year-old-with-bl-pedal-edema-facial.html

https://prathyushamulukala666.blogspot.com/2023/02/edema-facial-puffiness-and-sob-this-is.html

https://priyadarshinitripuram.blogspot.com/2023/04/nicardia-trends.html?m=1

23M Nephrotic Syn, 18yrs, Cushings, Diabetes, Hypothyroidism Telangana PaJR

 

12-06-2025

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS 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 THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

BRIEF HISTORY

23 year old male admitted in SICU

For right lower limb cellulitis with ? Necrotising fascitis 

At the age of 5-6years

 patient had anuria with anasarca and was 

Diagnosed to have nephrotic syndrome 

Initially was started on steroids

Later diagnosed as steroid resistant nephrotic syndrome biopsy -FSGS (2014)

Was treated with Iv rituximab 2doses

Followed by Azathiaprine 2014 to 2017

2017 -Started on Calcineurin inhibitors - tacrolimus

Had complete remission from 2017 to 2021

1/20 - on complete remission with tacrolimus treatment.

2 /21 -Tacrolimus stopped to due to 

? Tacrolimus induced uncontrolled sugars

Followed by relapse

10/21 - 2nd dosage of IV rituximab 2doses given 

Irregular follow-up and no consultation for 3years.

During these years was on tacrolimus 0.5mg

Telmisartan 20mg atorvastatin 20mg

And metformin 500mg bd

Also diagnosed with hypothyroidism and is on thyronorm 12.5mcg

12/2024- went for follow up again 

With c/o bilateral pedal odema

Was started on tab prednisolone 40mg and tab.Mycophenolate Moefitil 360mg now on Prednisolone 10mg weekly once (Mycophenolate stopped 3- 4months back).

22F Lupus Nephritis, Past Azt Pancreatitis, Pyopneumothorax, Meningitis Telangana PaJR

 

Thursday, August 15, 2024

20F Lupus clinical complexity EHR deidentified horcrux links to all three admissions and follow up

 Summary: 

This patient was first presented to Prof Michele Meltzer  in Jan 25, 2022 (link: https://youtu.be/X5NBa_0VVUw?feature=shared) in this CPD linked here: https://medicinedepartment.blogspot.com/2022/12/?m=1 and she first presented to the presenters in September 2022 which is recorded in the link below but to summarise it drastically, she had nephrotic glomerular proteinuria, cutaneous vasculitic lesions, CNS vasculitic lessons (investigated for altered cognition) and endocardial and pericardial inflammation (acute heart failure with pericardial effusion)that was attributed to lupus in view of a strong ANA positivity particularly of the ds-dna fraction in ELISA. https://medicinedepartment.blogspot.com/2024/08/first-admission-september-2022-20f-with.html?m=1

Second admission: She again got admitted in December 2022 with headache, altered sensorium and meningeal signs, which was associated with a minor CNS bleed on MRI was later attributed to warfarin (link:

https://drsaicharankulkarni.blogspot.com/2022/12/20f-sle.html?m=1

Her discharge after September 2022 was relatively uneventful on immunosuppressives and while her cardiac and CNS issues were the first to resolve even during admission, her proteinuria also subsided and she gradually withdrew all immunosuppressives in a year with a brief period of iatrogenic Cushing in between. Recently in June 2024, she presented with an ankle flare along with anasarca that also revealed a nephrotic relapse on evaluation of 24 hour urine protein as archived in her PaJR conversations here:https://drsaicharankulkarni.blogspot.com/2022/12/20f-sle.html?m=1

Her 3rd admission recently in July 2024 was for a right hypochondrial pleuritic pain that ultimately revealed a large hydropneumothorax along with multiple lung abscesses. Again this was possibly an iatrogenic result of the high dose immunosuppressives for just a month! There's still a persistent diagnostic uncertainty around the etiology of her lung abscesses and hydropneumothorax as her dry cough persists and her last antibiotics choice was quinolone!https://drsaicharankulkarni.blogspot.com/2022/12/20f-sle.html?m=1