He had a history of DM (15 years), HTN (8 years), brain stroke (2 years), HBsAg positivity. From last the middle of the 2018 year, he has been feeling severe pain in both hands and legs. However, since the middle of last year, he has been unable to sit in the chair in his chair as legs were swelling and unable to stand easily from sitting position.
Currently, he is getting a fever associated with pain. He had a history of LBP with radiculopathy, weakness of B/L lower limbs, knee pain, hand small JTS pain, fever, shoulder, mild giddiness, and generalized body weakness. Previous clinical examination findings show no sensory issues, ++ DTR in all, planter reflex decreased (?), SLR negative, no coordination problem, Rhomberg sign negative, Hepatitis B viral (HBV DNA) quantitative 32 IU/ML [HBV detected with linear range of the assay] Serum anti-HBe 0.15 (<=1.00 is reactive i.e. resolution of infectious state]; Brain MRI: Left temporal fossa arachnoid cyst right centrum semiovale and pontine lacunar infarctions, small vessel ischemic changes, diffuse cerebral atrophy; MRI SI joints revealed no significant abnormality; Normal LFT with borderline low serum albumin (3.88 (3.97)] High TG [175 mg/dl (<150)]; Salmonella typhi IgM negative; ASO titRe 217 IU/ml; CRP 7.42 mg/dl; Setum RF <20 IU/ml (negative); Serum anti-cyclic citrullinated peptide <0.5 U/ml; Antinuclear antibody-negative; HLA B27 negative
Serum vitamin B12 high, serum vitamin D normal, normal serum calcium, phosphorus, other electrolytes except a borderline rise in serum potassium [5.16 (5.1)]; HbA1c 6.3% (FBS 107 mg/dl)' normal urine RE; normal ECHO with concentric LVH; hbA1c 8.7%; Degenerative disc changes in cervical and lumbar spines on MRI; LS Spine x-ray revealed degenerative changes (osteopenia, multiple levels osteophytes).
I think methotrexate was started due to raised CRP, raised ESR (95), fever, polyarthritis, ostepenia in xray hand. he has multiple degenerative changes at multiple levels in the vertebral column which may not be causing muscle weakness in limbs. I could not find any notable complications of diabetes e.g., in kidney or heart. But he has stroke which might partially be contributed by DM.
Dakther babu ANAK Dr, Dakeayche KONO Upokar na paya Aponadar Akta Advice kub Darkar
উত্তরমুছুনDakther babu 2nd SDO sAHAB Jachay
উত্তরমুছুনHe had a history of DM (15 years), HTN (8 years), brain stroke (2 years), HBsAg positivity. From last the middle of the 2018 year, he has been feeling severe pain in both hands and legs. However, since the middle of last year, he has been unable to sit in the chair in his chair as legs were swelling and unable to stand easily from sitting position.
উত্তরমুছুনCurrently, he is getting a fever associated with pain. He had a history of LBP with radiculopathy, weakness of B/L lower limbs, knee pain, hand small JTS pain, fever, shoulder, mild giddiness, and generalized body weakness. Previous clinical examination findings show no sensory issues, ++ DTR in all, planter reflex decreased (?), SLR negative, no coordination problem, Rhomberg sign negative, Hepatitis B viral (HBV DNA) quantitative 32 IU/ML [HBV detected with linear range of the assay] Serum anti-HBe 0.15 (<=1.00 is reactive i.e. resolution of infectious state]; Brain MRI: Left temporal fossa arachnoid cyst right centrum semiovale and pontine lacunar infarctions, small vessel ischemic changes, diffuse cerebral atrophy; MRI SI joints revealed no significant abnormality; Normal LFT with borderline low serum albumin (3.88 (3.97)]
High TG [175 mg/dl (<150)]; Salmonella typhi IgM negative; ASO titRe 217 IU/ml; CRP 7.42 mg/dl; Setum RF <20 IU/ml (negative); Serum anti-cyclic citrullinated peptide <0.5 U/ml; Antinuclear antibody-negative; HLA B27 negative
Serum vitamin B12 high, serum vitamin D normal, normal serum calcium, phosphorus, other electrolytes except a borderline rise in serum potassium [5.16 (5.1)]; HbA1c 6.3% (FBS 107 mg/dl)' normal urine RE; normal ECHO with concentric LVH; hbA1c 8.7%; Degenerative disc changes in cervical and lumbar spines on MRI; LS Spine x-ray revealed degenerative changes (osteopenia, multiple levels osteophytes).
I think methotrexate was started due to raised CRP, raised ESR (95), fever, polyarthritis, ostepenia in xray hand. he has multiple degenerative changes at multiple levels in the vertebral column which may not be causing muscle weakness in limbs. I could not find any notable complications of diabetes e.g., in kidney or heart. But he has stroke which might partially be contributed by DM.