And previous investigations he had met the physician in his rural area where he got a hp percentage done she was nine point five grams csr was undone to rbs was 102 milligrams per deciliter hiv was negative on examination he had a non evening also for both deshun which was of one enough year duration and he had met several physicians who are unable to treat me
Otherwise all the systemic examination was unremarkable he was referred to san vicente later on he was admitted that katie chandler hospital visit which is an associate of general santa is a multi speciality with the paradise you facility in some pathetic so where i am the consulting position and i happen to also see the case so he doctor as a bit of chandra shekar
Started him on prednisolone with one milligram per kg body weight and simultaneously we started him on ahsoka print 50 milligram daily which we gradually scaled from 25 milligram unfortunately the patient developed nausea and diarrhea which we could not correct it maybe we thought it was because of the other parent itself which is a side effect of azathioprine again
He was continued on spirit we just hope that they also would heal and unfortunately patient again he came back to us after a month again by this time he could not already the area he had repeated episodes of diarrhea it was uncontrollable we stop there as a tap and stop it in one mycophenolate but see what was continued his other investigations showed that area
Was negative uncovers negative c3 was 120 crp was to 1 milligram per deciliter hbsag was negative but by a skin biopsy showed small vessel vasculitis the diagnosis of unclassified vas playtest was that his chest x-ray and paranasal sinuses were normal now again after few after about a month again he came up we examined him and we saw that he came with an history
Of severe pain nezha right thigh and hip and he was unable to walk or bear weight so he was literally carried to the hospital now we had a dilemma what could be the reason for his bone scan showed there was to be at osteoporosis which two are you can make him walk and we’ll go to the graveyard so it was rightly so now we could able to read his vasculitis which he
With a non-healing ulcer what he pays for vana na kiya was solved within one or another of months now you develop osteoporosis with navitus a raspa necrosis metabolic disturbances in electrolyte disturbances which we started treating on fitting them and now the 0s as it is it is a double-edged sword so which needs to be which we have to be careful in judging of
How to what extent or what is the effectiveness of steroids and how well the other treatment would be useful in such a patient so as in this case the patient also had myopathy so now his vasculitis is under control now he has become a bedridden patient where he had to undergo was the treatment for osteoporosis years it’ll go up put on this phosphonate and insulin
And he because of a vascular neck process we are waiting to see that the improves gradually so this is a very good example we thought it will be an ideal on this forum to present to talk about this case thank you i would like to take this operation to present to unusual
Transcribed from video
2008-Clinical Case By Dr murli By ChanRe Ricr