Jaccoud's Arthropathy with Mucocutaneous Inflammatory Gangrene

31 yr old female come to the hospital with c/c of fever of high grade and jaw pain since 15 days.. pt was apparently alright 20 days back, then she had a trauma (got hit by wooden stick) over right small toe during work.. after 10 days she developed high grade fever,continuous type a/w chills and rigors, subsided without medication. No other positive history.
Past history: pt developed sudden deformity in joints of both hands and toes 16 yrs back during her 1st pregnancy (6th month) since then there is no progression of deformities.she had two children there after. clinical picture relates more to rheumatoid arthritis but only distal small joints are involved. so can it be systemic lupus erythematosus ? Jaccoud's arthropathy
On examination vitals are stable..
hyperextension at proximal inter-phalyngeal joints and flexion at distal inter-phalyngeal joints of both right and left hands is seen.

spleenomegaly +

Dental history and examination
pt is c/o of loosening of teeth and pain since 2 months

calculus is one the inner aspect of lower lip, soft in consistency, scrapable with yellowish slough, bleeding is seen. Yellowish white coating is seen on the tongue with restricted tongue movements and ulceration of musosa of floor of the mouth and lingual sulcus. Stinking smell (so much that we can appreciate even from 10 feet distance).. suspecting Acute Necrotising Ulcerative Gingivitis (ANUG)
Foot examination
Ulcerative traumatic lesion rt foot.. bleeding from the site. suspecting pyoderma gangrenosum
Investigations:
RA factor + 12
CRP+ 1.2mg/dl
ESR 100mm/1hr
Counts 1700
Hb% 7.4
Iron studies:
Iron 53.5, Ferritin 16, TIBC 513
Viral markers non reactive


LATERAL PICTURE OF BOTH HANDS SHOWING TYPICAL SWAN NECK DEFORMITY
DORSAL ASPECT

PALMAR ASPECT



PICTURE SHOWING SPARING OF WRIST JOINT and DEFORMITY OF TOES CAN ALSO BE NOTED

PICTURE SHOWING SPARING OF WRIST JOINT

X-RAY BOTH HANDS


ACUTE NECROTISING ULCERATIVE GINGIVITIS




? PYODERMA GANGRENOSUM
the pt is having h/o fixed drug eruptions
today she developed pustules all over her body

                  




Final Diagnosis
Acute Necrotising Ulcerative Gingivitis (ANUG) with pyoderma gangrenosum
?Rheumatoid arthritis
?Jaccoud's Arthropathy

Comments

Post a Comment

Popular posts from this blog

Just an epigastric discomfort?

Image
JUST AN EPIGASTRIC DISCOMFORT?? Disclaimer: This is a HIPAA de-identified open-online-patient-record with patient information posted here after collecting informed patient consent. 42 yr old male is complaining of Burning sensation in the upper abdomen since 1yr. pt tells ''6 months back I had severe pain in right side of my upper abdomen for a week for which I was treated with medication and relieved from pain.. Now i was here because i couldn't get rid of this burning sensation in the upper abdomen which aggravates though I takes food or not.. so i take antacids frequently but of not much use. no h/o smoking or alcohol, no other addictions... also complaining of constipation and burning micturition since 3 months.. and occasional vomitings.  past history and family history are nil significant. on examination his carotid body pulsations are felt.. on suspecting hypoxia his spo2 was measured and is found to be within normal limits.(97%). His investigations are as fol
Read more

HCV due to Dialysis??

Image
This is a graph showing the course of illness in the patient before he was referred to us. The  patient in 2016 had fever for which he got all the routine investigations done and the reports were absolutely  normal.In  July,2017 he had fever and generalised body pains for which he was treated by a doctor at a local hospital. His fever subsided after 5 days but his body pains persisted for 2  months for which he used some medication for 1 month 15 days. After  2 months in  september , 2017 he consulted the same doctor for persisting body pains. The doctor advised for few investigations for which the patient went to a hospital in  hyderabad  and got the tests  done.Here  they informed him that his kidney functioning  wasn't  good and his serum creatinine was 8.9 mg/dl and he needs to be initiated on  Hemodialysis.(but the pt was completely asymptomatic except for his body pains).He  underwent 2 cycles of  Hemodialysis  after which he got an  Arteriovenous  fistula done and then
Read more

Jaccoud's Arthropathy with AKI

Image
25 yr young lady had vomitings 2 episodes , diarrhoea 2 episodes and then felt giddy, loss of consciousness, for which she went to local hospital and there she was given glucose (2 bottles) After which she developed abdominal dissension followed by facial puffiness followed by swelling of upper limbs and lower limbs. Associated with decreased urine output and was referred to higher centre.. all of a sudden she was diagnosed as C/O ACUTE KIDNEY INJURY... and she was on Dialysis. Past history:she was 3rd child for her mother after 2 girls.. no h/o birth injury. mile stones achieved as per age.  she was normal up to her age of 12yrs. One day she developed low grade fever after 2 days she developed swelling in her right knee.. she was unable to squat. Unable to flex her knee.. not a/w any pain and swelling subsided after few days.. she was  normal for about 6 months then she had an episode of low grade fever on and off for duration of about 6 months, during which she was completely bed r
Read more