shirish_sss
Forum Senior
Topics: 32
Posts: 134
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A 62 YEARS OLD WHITE MALE WAS REFERRED TO AN OPTHALMOLOGIST BECAUSE OF RECURRENT BILATERAL RED EYES AND LID SWELLING, WHICH THE PATIENT SAYS STARTED BEFORE A YEAR. ONE OR BOTH EYES WOULD BECOME INFLAMMED AND STAY SO UNTIL WAS GIVEN A SHORT COURSE OF ORAL PREDNISOLONE. HE WAS BEING GIVEN TREATMENT FOR ALLERGIC CUNJUCTIVITIS, BOTH TOPICAL AND SYSTEMICALLY, AND HE HAD BEEN TREATED FOR ONE EPISODE OF IRITIS. EXAMINATION REVEALED AN INFLAMMED , SWOLLEN, AND TENDER RIGHT EAR AND A RED RIGHT EYE. THE PINNA OF EAR WAS INVOLVED , BUT THE EAR LOBE WAS SPARED. NO EVIDENCE OF NASAL DEFORMITY OR INFLAMMATION. OCULAR EXAMINATION REVEALED DIFFUSE CONJUNCTIVITIS AND EPISCELRITIS ON RIGHT SIDE. THERE WERE OLD POSTERIOR SYNECHIAE BETWEEN THE LENS AND IRIS, INDICATING PRIOR ANTERIOR UVEITIS.
PATIENT GAVE HISTORY OF AORTIC VALVE DYSFUNCTION DIAGNOSED PREVIOUSLY.
LAB REPORT.......
1) MICROHEMATURIA
2) MILD LEUCOCYTOSIS
3) ANEMIA
4) RAISED ESR
5) RAISED SERUM TOTAL PROTEINS
6) NEGATIVE RA FACTOR AND NEGATIVE ANA TEST AS WELL AS NEGATIVE SYPHILIS SEROLOGY
WHAT IS YOUR DIAGNOSIS....?
HOW WILL YOU MANAGE THIS PATIENT.....?
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| smitha
Forum Elite
Topics: 53
Posts: 236
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Well, shirish,it's a good q..................
and , i guess, this is a case of "RELAPSING POLYCHONDRITIS", if iam not wrong!!!!!!!!
This is a rare ds., of unknown cause,inflmmatory process, which involves principally the ears, nose, trachea and larynx(cartilaginous strs.).
It is usually episodic in and equal in males and females.Cartilage is painful,swollen, and tender during an attack and eventually becomes atrophic, resulting in permanent deformity.
Fever, episcleritis,uveitis,deafness,aortic insufficiency, and rarely glomerulonephritis r non-cartilaginous manifestations.
In most pts. there is a migratory,aymmetric, seronegative, polyarthropathy affecting small, large jt. sand costochondral junctions.
TREATMENT:
Prednisone 1mg/kg/d OR dapsone if chronic high dose steroid is required(to spare it)..........
Involvement on tracheobronchial tree leading to collapse, requires PROMPT TRACHEOSTOMY!!!!!!!!!!!
Hope iam right!!!!!!!!!! 
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| smitha
Forum Elite
Topics: 53
Posts: 236
|
Well, shirish,it's a good q..................
and , i guess, this is a case of "RELAPSING POLYCHONDRITIS", if iam not wrong!!!!!!!!
This is a rare ds., of unknown cause,inflmmatory process, which involves principally the ears, nose, trachea and larynx(cartilaginous strs.).
It is usually episodic in and equal in males and females.Cartilage is painful,swollen, and tender during an attack and eventually becomes atrophic, resulting in permanent deformity.
Fever, episcleritis,uveitis,deafness,aortic insufficiency, and rarely glomerulonephritis r non-cartilaginous manifestations.
In most pts. there is a migratory,aymmetric, seronegative, polyarthropathy affecting small, large jt. sand costochondral junctions.
And the most important thing here, which will differentiate from a cellulitis of ear, is the SPARING OF LOBULE WHICH IS A NONCARTILAGINOUS STR. .........
TREATMENT:
Prednisone 1mg/kg/d OR dapsone if chronic high dose steroid is required(to spare it)..........
Involvement on tracheobronchial tree leading to collapse, requires PROMPT TRACHEOSTOMY!!!!!!!!!!!
Hope iam right!!!!!!!!!!
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| smitha
Forum Elite
Topics: 53
Posts: 236
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oops i guess, it's twice again in the reply..........i just wanted to add the "cellulitis " thing that's all........... 
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| shirish_sss
Forum Senior
Topics: 32
Posts: 134
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GREAT ANSWER SMITHA :lol: :lol: :lol: :lol: :lol: .............
IT'S DEFINITELY RELAPSING POLYCHONDRITIS......
YOUR EXPLANATION IS TOTALLY CORRECT..........
IN STEROID RESISTANT CASES SOMETIMES WE HAVE TO RESORT TO IMMUNOSUPPRESSIVE THERAPY LIKE AZATHIOPRINE.........
YOU ARE CORRECT IT'S A RARE DISORDER..........................
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| dr_perfect_stranger
Forum Newbie
Topics: 2
Posts: 25
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but Sirish and Smitha please tell me......How come u ppl have knowledge of everything........
Even after scoring max in step 1 i am not able to answer such things....
do guide me about books for step2............
Best of Luck u 2
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| smitha
Forum Elite
Topics: 53
Posts: 236
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Hey DPS..........
Thanx for ur wishes and compliment.........but i guess, it's not that i know everything.........it wud be toooo high to say that ........iam just somebody like u, who's trying to prepare for step2 which is coming up, in all possible ways and efforts,that's all.................
GOOD LUCK TO U TOOOO
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| shirish_sss
Forum Senior
Topics: 32
Posts: 134
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hi dear dps....
thnx for your wishes....
I WOULD SAY THAT EVERY DOC IS A UNIQUE GENIUS....
I MAY BE DIFFERENT FROM YOU..YOU MAY BE DIFFERENT FROM SMITHA..AND SHE MAY BE DIFFERENT FROM ME...
WE ALL HAVE SOME WEAKNESS AND SOME PLUS PPOINTS...
WE ALL READ MORE OR LESS SAME REVIEW BOOKS....
I READ HARRISON'S AND KAPLAN'S STEP-2 NOTES...THAT'S ALL....
PLUS I WOULD SUGGEST ONE MORE THING THAT WILL BE USEFUL FOR THIS FORUM AND YOU IN PARTICULAR...
MEDICAL SCIENCE IS A EVER CHANGING FIELD...
AND THE BOARD EXAMS KNOW THIS WELL..
THEY HAVE A CONSIDERABLE NUMBER OF QUESTIONS OUT FROM OUR REVIEW BOOKS OR NOTES..
INFORMATION ABOUT THIS WE FIND IN MEDICAL WEB-SITES AND JOURNALS...
WHICH KEEP ON UPDATING LATEST TRENDS..
FOR Eg. THERE CAN BE A QUESTION ON NSAIDS BEING PROTECTIVE FOR ALZEIMER'S DISEASE....WHICH IS NOT MENTIONED ANTWHERE IN ANY BOOK BUT MAY BE THERE IN NEXT COMING EDITION OF HARRISON'S....BUT THESE INFORMATION IS SURELY GIVEN HERE AND THERE....SOMEWHERE.....
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