46YR OLD FEMALE WITH INVOLUNTARY MOVEMENTS OF UPPER AND LOWER LIMBS
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Since then she is on routine followup with hemogram and serum creatinine levels,and her baseline creatinine levels were 3.2mg/dL.
In June 2022, she developed fever and cough associated with shortness of breathe . On CT chest peripheral ground glass opacities and septal thickening were noted
later after few days, she developed swelling of both lower limbs upto ankles
Then she underwent dialysis for the first time through right IJV line, for 4 hours and was on conservative management for 2-3months.
3 months later, she developed fluid filled blebs over the fingers of hand
she also had eroding and distorted nails and hyperpigmented macules over the face, and itching over the palms, and low grade fever associated with loss of apetite and alopecia, she also developed ulcers on palms and finger tips associated with burning sensation
she was investigated for ANA profile . Positive for Anti Ro 52 and SSA/Ro 60++, and SSB/La+.
In November she developed cough since 1 week,with whitish color sputum, mucoid in consistency and moderate in amount and non blood stained and non foul smelling
and bilateral swelling of lower limbs till knee,not associated with any redness or trauma,and decreased urine output for 2 days,
and Shortness of breath MMRC grade 3, and loss of apetite, no abdominal distension, constipation, diarrhoea, facial puffiness, headache and seizure activity at that time,
and she was diagnosed as? Antisynthetase syndrome
withCLD secondary to autoimmune hepatitis with hypoalbuminemia
along with acute exacerbation of ILD,and recurrent anemia.
In December,in view of further increase in SOB, and abdominal distension she was taken to second session dialysis, antibody profile was repeated
and bronchoalveolar lavage was performed and was found to be having an infective etiology and mucus plugs in the airways.
On radiograph of chest, she was found to be having left lower lobe consolidation, and PET CT was advised and was done,and they suspected Tuberculosis for which she was on ATT
IMPRESSION ON PET CT: PET CT shows left lung consolidation, mediastinal nodes, minimal pleural effusion, spleenomegaly, diffusely thickened peritoneum
CURRENT SITUATION:
she developed sudden involuntary movements of upper and lower limbs on 3rd of january at 5 am
Similar episode was repeat at around 6 am
At hospital similar episodes occurred around 8 am
Recurrent episodes occurred and each episode lasted for 2mins
In the view of recurrent seizures CT brain was done
Inj lorazepam was given,
Later levitracetam
and then sodium valproate given as her seizures were not controlled.
Later she had continuous episode of seizures lasting for more than 45 min, then she was sedated with IV MIDAZOLAM and intubated.
General examination:
Patient is sedated
On inspection, she has hyperpigmentation on her face and upper limbs
VITALS:
Temperature:afebrile
BP 160/110mmhg
Pulse 158bpm
RR 37 cpm
SYSTEMIC EXAMINATION
CVS : S1,S2 heard. No murmurs
RS : Bilateral air entry present
Normal vesicular breath sounds were heard
CNS
As the patient is sedated, I didn't elicit Sensory examination, Motor examination
Reflexes:
Rt. Lt
Biceps: 2+ 2+
Triceps 2+. 2+
Supinator. A. A
Knee. A. A
Ankle A. A
PROVISIONAL DIAGNOSIS
STATUS EPILEPTICUS
with CHRONIC KIDNEY DISEASE since13 years with AUTOIMMUNE INVOLVEMENT
Investigations
3/1/2023
On 4/1/23
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