CASE HISTORY NAME Age Sex

CASE HISTORY NAME : Age : Sex : Marital Status: Occupation : MARJINA BEGUM About 25 year Female Married House wife.

Address : Vill : Kujghar, Post : Kujghar, P. S. : Sadar, Dist : Jamalpur. Date of Admission: 08 -11 -2005 Date of Examination: 09 -11 -2005

CHIEF COMPLAINTS Diffuse painful blisters & crusted lesions over scalp, face, trunk, upper extrimities & groin. For about 1½ month. A few small blisters in mouth cavity For 7 days.

H/O PRESENT ILLNESS The patient states that she was all right about six months back. Then she developed a few blisters with itching at lower part of back of Lt painful blisters

side. Subsequently after 4 months she developed various sizedassociated with itching at her chest, back, upper extrimities, scalp, face, groin & a few painful lesions is oral mucous membrane which became crusted,

With above complaints she was admitted in College Hospital Mymensingh for Medical proper management. exfoliative, reddened with moist surface

H/O PAST ILLNESS. Nothing contributory. Personal History: Married for 4 years. No issue. Menstruation : Regular. Habit chewing of battle nut +

Family History: No any of her family members suffered from any such notable disease.

Treatment History: Patient was admitted with complaint mentioned in MMCH on 20 -10 -2005 & was treated with long acting steroid triamcinolone acetonide parenterally & was improved.

GENERAL EXAMINATION. Appearance : Body build : Anaemia Jaundice Cyanosis Ill looking. Average. Absent.

Oedema Dehydration Clubbing Koilonychia Hair Nail Absent Normal

Pulse : 86/min/reg/mod. B. P : 120/35 mm of Hg. Temp : Normal Respiration : 14/min. Neck veins : Not engorged. Lymph Node : Not palpable.

EXAMINATION OF INTEGUMENTARY SYSTEM. Inspection Vesicles & bulla on scalp, face, chest, back, upper extrimities, groin, some on normal skin & some are erythomatous based.

Palpation : Vesicles & bullae are flacid, tenderness present NIKOLSKY Sign Present. Bulla – spread plenomenon (The Asboe. Hansen sign) – Present.

EXAMINATION OF OTHER SYSTEM : NAD lesions. except a few oral mucosal

SALIENT FEATURES. Marjina Begum, Age about 25 years of vill Kujghar, Jamalpur was admitted in MMCH on 08 -11 -05 with complaints of progressive development of painful blisters. Crust, erosions & exfoliative lesions associated with itching

over scalp, face, trunk, upper arms, groin & a few small painful blisters in oral cavity. Examination shows flaccid & vesicles, Bullae, crusted & exfoliative lesions with erythomatous base at the mentioned sites. The lesions are

tender, moist with malodourous condition & a few superficial erosions in oral mucous membrane. Nikolsky sign – Present Bulla – Spread Phenomenon – Present.

PROVISIONAL DIAGNOSIS. Pemphigus foliaceous. D/D. : Pemphigus Vulguris. Pemphigus vegetans. Bullous Pemphigoid. SSSS Cicatrical Pemphigoid. Stevens johnson syndorme & TEN.

INVESTIGATION. Skin biopsy for Histopathology & IF test. Blood for TC DC Hb% ESR 6600/cmm. N-62%, L-32%, M-02%, E-0%, Hb%80%, ESR- 10 mm/1 st hour.

Random blood suger. - 103 mg/100 ml. Urine for R/E. - NAD Blood Urea. - 18 mg/100 ml. Serum creatinine. - 1. 0 mg/100 ml.

BIOPSY FOR HISTOPATHOLOGY : Finding : Pemphigus compatible with pemphigus foliaceous. CONFIRMATORY DIAGNOSIS. Pemphigus foliaceous.

TREATMENT. Inj. - TRIAMCINOLONE ACETONID 1 AMP I/M stat and 1 amp on 3 rd day & 1 amp on 7 th day. Tab. - Prednisolon -80 mg/day. Tab. - Neotack (150 mg) 1+0+1 daily.

TREATMENT(Contd). Cap. - Sefradine (500 mg)1+1+1+1 daily. Tab. - Alatrol 0+0+1 daily. Potash wash - daily. 1% Silver sulphadiazine ointment daily.

SALIENT FEATURE. Mr. Sumon Das, son of Dr. Kanu Das, aged 29 years hailing form Jamalpur was admitted in MMCH, Cabin-7 on 28 th November, 2005. He was referred to skin & VD OPD on 30 th Nov. 05 with the complaints of exfoliation of

skin with generalized mild itching for 20 days, a known case of hypothyroidism due to thyroidectomy 3 months back & bronchial asthma from childhood. On examination we found extensive scaling all over the skin with erythema

and itching, mild leg oedema & puffy face. Pt’s pulse was 96/min, BP= 120/65 mm of Hg, temp. = 101. 40 F, lungs, heart & urinary output – normal. There was no mucous membrane and nail changes. Pt. also complaints of

chilling & gave H/O taking tab. Ibuprofen 20 days back and also paracetamol & azithromycin. With these above features our diagnosis is drug induced exfoliative dermatitis.