Joints not so jointed?
A 28yr old female resident of ramannagudem came to the OPD with C/O
- Multiple large joints since 2 months A/W loss of appetite and low grade fever.
Patient was apparently asymptomatic 2 months back when she had a missed period and when UPT tested — was positive(indicating pregnancy) .
Few days later she developed left foot pain initially in the EARLY MORNING- BURNING TYPE when pain progressed to the other side(right side). Then joint pains were ASCENDING and involved KNEE, HIP joints within 1 month, with left knee joint swelling since 15-20 days.
WRIST PAIN since 20 days and DIFFICULTY IN FISTING the hand since 10-15 days. No upper limb joint pains.
FEVER since 1 month- evening rise of temperature. No cough , no loose stools, no vomitings.
H/O MTP 1yr back for unplanned pregnancy.
N/K/C/O DM, HTN,CAD,ASTHMA,TB
PERSONAL HISTORY:
Appetite-normal
Diet-mixed
Regular bowel and bladder movements
No addictions
FAMILY HISTORY:
Not significant
OBSTETRIC HISTORY:
H/o MTP 1yr back for unplanned pregnancy.
Present pregnancy:10weeks of gestation
On examination:
Pt is conscious coherent cooperative
No pallor ,icterus, clubbing,cyanosis,generalised lymphadenopathy,pedal edema
STIFFNESS OF WRIST JOINT +
LEFT ANKLE JOINT- SWOLLEN
Vitals on admission:
Pt is afebrile
Bp:110/70mmhg
Pr:68bpm
Rr:16cpm
Spo2: 98% at ra
Cvs:s1s2+
Rs:bae+
P/a:soft,non tender
Bowel sounds+
Cns:NAD
INVESTIGATIONS-
PROVISIONAL DIAGNOSIS:
?SPONDYLOARTHROPATHY secondary to CHIKUNGUNYA?
1st trimester pregnancy(2nd month)
TREATMENT :
1.Tab.DOLO 650MG PO/SOS
2.TAB.MVT PO/OD@ 4PM
3.Monitor vitals
4.tab.HYDROXYCHLOROQUINE 100MG H/S
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