Jaccoud's Arthropathy with AKI
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 ridden unable to get up due to weakness but no h/o any joint abnormalities. Her mother used to feed her milk with spoon. She lost lot of weight and was refused from school due to her frequent ill health.. the girl depressed and deteriorated further.. at the age of 15 yrs.. she developed high grade fever on and off a/w joint stiffness in both hands.. at the age of 18 she was advised surgery but refused due to financial constraints. H/o delayed menarche. she attained menarche at 22 yrs.
And now she presented with the above complaints..
per abdomen: abdomen is tense, distended, umbilicus everted, no gaurding, no rigidity, no organomegaly.
on neurological examination
bulk: equal on both sides
tone: normal in both upper and lower limbs
power: normal
Reflexes: Areflexia with B/L plantar extensor
peripheral neuropathy
Sensory examination: normal
No cutaneous manifestations
USG chest:
e/o Air sonograms noted in the right basal zones
e/o free fluid noted in the right and left pleural space (rt>left)
impression:
basal consolidation of right lung
right minimal pleural effusion
USG Abdomen:
moderate ascites
left ovarian cyst (2.2*1.8cm)
LDH 564 IU/L (on 12/3)
Recently one evening after dialysis pt had passed stools 4 times.. 2 episodes of vomiting.. she suddenly complained of shortness of breath..
Temp:100.8
HR 121bpm
RS 33cpm
O2 was administered.
Pt developed abdominal distension.. foleys gave no urine output. She complained of severe abdominal pain.
P/A tense, tenderness+ no guarding and rigidity.
What is the reason for her sudden onset of symptoms?
USG, XRAY erect abdomen, Plain CT abdomen was done..
USG showed acaluclus cholecystitis, moderate ascites and collapsed bowel loops
XRAY erect abdomen picture attached
Plain CT abdomen showed collapsed bowel loops..
(ruled out perforation)
2D ECHO: Mild MR and Mild TR, Mild PH
Final diagnosis:
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 ridden unable to get up due to weakness but no h/o any joint abnormalities. Her mother used to feed her milk with spoon. She lost lot of weight and was refused from school due to her frequent ill health.. the girl depressed and deteriorated further.. at the age of 15 yrs.. she developed high grade fever on and off a/w joint stiffness in both hands.. at the age of 18 she was advised surgery but refused due to financial constraints. H/o delayed menarche. she attained menarche at 22 yrs.
And now she presented with the above complaints..
per abdomen: abdomen is tense, distended, umbilicus everted, no gaurding, no rigidity, no organomegaly.
on neurological examination
bulk: equal on both sides
tone: normal in both upper and lower limbs
power: normal
Reflexes: Areflexia with B/L plantar extensor
peripheral neuropathy
Sensory examination: normal
No cutaneous manifestations
USG chest:
e/o Air sonograms noted in the right basal zones
e/o free fluid noted in the right and left pleural space (rt>left)
impression:
basal consolidation of right lung
right minimal pleural effusion
USG Abdomen:
moderate ascites
left ovarian cyst (2.2*1.8cm)
 |
| PALMAR ASPECT OF HAND SHOWING SUBLUXATION |
 |
| DORSAL ASPECT OF HANDS SHOWING SUBLUXATION |
 |
| LATERAL PICTURE OF HAND SHOWING DEFORMITY |
 |
| WRIST JOINT IS SPARED |
 |
| WRIST JOINT IS SPARED |
LDH 564 IU/L (on 12/3)
Temp:100.8
HR 121bpm
RS 33cpm
O2 was administered.
Pt developed abdominal distension.. foleys gave no urine output. She complained of severe abdominal pain.
P/A tense, tenderness+ no guarding and rigidity.
What is the reason for her sudden onset of symptoms?
 |
| DURING THE EVENT |
USG, XRAY erect abdomen, Plain CT abdomen was done..
USG showed acaluclus cholecystitis, moderate ascites and collapsed bowel loops
XRAY erect abdomen picture attached
Plain CT abdomen showed collapsed bowel loops..
(ruled out perforation)
 |
| XRAY ERECT ABDOMEN |
2D ECHO: Mild MR and Mild TR, Mild PH
 |
| NEXT DAY MORNING |
Acute Gastroenteritis
right lower lobe consolidation
ACUTE KIDNEY INJURY
Anemia
?Jaccoud's Arthropathy
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