60 year old male with asymptomatic skin lesions, fever, epistaxis

A 60 year old male patient presented to Dermatology OPD with skin lesions, fever, epistaxis

July 9, 2023

Hello, I am Harika Madala, a 5th sem medical student.
THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS/HER GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT

Chief complaints
Asymptotic skin lesions over skin since 4 years
Painful skin lesions over hands, legs, fever, epistaxis since 2 months
Decreased sensations over lesions since 2 months
Swelling of both ears since 3 months, 
Pain since 2 months
Generalized lymphadenopathy

History of Presenting Illness
Patient was apparently asymptomatic 4 years back then developed asymptomatic white skin lesions over both feet.
Painful akin lesions since 2 months
Decreased sensation over lesions since 2 months
Swelling of both ears since 3 months, pain since 2 months 
A large lymph node was identified in the axilla region
Generalized lymphadenopathy 
Past history
No similar complaints in past
Nk known comorbidities
On MB MDT since 10 days
Treatment history
On MB multi drug therapy since 10 days
Personal history
Married
Agricultural worker 
Normal appetite
Mixed diet
Regular bowel and bladder movements
No known allergies
Regular alcohol consumption
Family history
Not significant
Physical examination
General examination
Patient was conscious, coherent, cooperative
Moderately build and nourished
Pallor -
Icterus -
Cyanosis -
Clubbing -
Lymphadenopathy -present
Pedal edema -
Vitals
BP -120/80mm Hg
PR -80 bpm
RR -16/min
Temperature - afebrile
Systemic examination
Cardiovascular system
Thrills - No
Cardiac sounds- S1 S2 heard
Cardiac murmurs - No
Respiratory system
Dyspnoea - no
Wheezing - no
Position of trachea - Central
Breath sounds- Vesicular
Abdomen
Shape of abdomen - Scaphoid
Tenderness - no
Palpable mass - no
Hernial orrifices - normal
Free fluids - no
Bruits - no
Liver - Not palpable
Spleen - Not palpable
Bowel sounds - Yes
Genitals- Bilateral inguinal lymphadenopathy with tenderness 
Central Nervous System
Conscious
Normal speech
No neck stiffness
Cranial nerves intact
Sensory & Motor system intact
Reflexes
                           Lt Rt
Biceps +2 +2
Triceps +2 +2
Supinator +2 +2
Knee +2 +2  
Ankle +2 +2
Skin
Multiple well-defined erythematous tender nodules over B/L arms,forearms,abdomen,pinna,anterior aspect of b/l legs
Investigations





















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