1601006092 final short case

 A 22 year old male came with chief complaints of distension of the abdomen and puffiness of the face since 8 months. 

History of presenting illness:

The patient was apparently asymptomatic 1.5 years back then he developed red itchy ring like lesions on his thighs for which he used over the counter clobeta gm improperly for 7 months. He also used Ayurvedic syrup which did not help his condition. He noticed increase in the lesions associated with weight gain, from 50 kgs to 70 kgs in Oct 2019. 

There no H/O of constipation, loose stools, fever, cough, abdominal pain, hair loss or thinning.

No H/O body pains, delayed wound healing, pedal edema, emotional liability, anorexia, easy fatiguability, decreased vision, weakness or acne

 No H/O usage of any oral steroids

Past history:

No H/O hypertension, DM, thyroid, CVS disorders, epilepsy, blood dyscrasias

Personal history:

• Diet: mixed
• Appetite: normal
• Sleep: adequate
• Bladder and bowel movements: normal
• No addictions

Family history:

Not significant

Drug history: 

H/O improper usage of clobeta gm for 7 months

General examination:

Patient is conscious, coherent and cooperative, moderately nourished and has an obese build

No pallor, icterus, cyanosis, clubbing, lymphadenopathy and edema

Puffiness of face is present

He has a distended abdomen with purple striae

Vitals:

Temp: afebrile

PR: 82 bpm

BP:120/80 mm Hg

RR: 20 cpm

Systemic examination: 

CVS: S1, S2 heard, no murmurs 

RS: bilateral air entry present, normal vesicular breath sounds heard, no added sounds

ABDOMEN: 

On inspection: 

• Abdomen is distended
• Purple striae are seen
• No visible pulsation, scars, sinuses, or engorged veins seen

On palpation: 

• No local rise of temperature
• Soft and non tender
• No organomegaly

Percussion: resonant

Auscultation: bowel sounds heard

CNS: no abnormality detected

Investigations: 

 Provisional diagnosis: 

Exogenous topical steroid-induced Cushing syndrome