DRUG INDUCED HEPATITIS SECONDARY TO BORDERLINE LEPROMATOUS LEPROSY DAPSONE SYNDROME

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31 year old male who is a photographer by occupation came to the casuality with complaints of 

Yellowish discolouration of sclera since 4 days,

Fever since 2 days  which is  insidious on onset , gradually progressive , subsided on medication. 

C/o Nausea and vomitings since 2 days Non -bilious and non projectile , food particle as content and was taken to local hospital in view of vomitings . 

HOPI:

Patient was apparently asymptomatic 17 years back then his mom observed hypopigmented patch over the cheek , and multiple hypopigmentation patches areas all over the body , neglected thinking it was due to vitamin deficiency, 15 days back mother observed a hypopigmented patch on the right arm and took him to a local hospital and was diagnosed with hansens and was on treatment since then.

No complaints of shortness of breath, palpitations , headache , orthopnea, PND . 

Non - Alcoholic 

Non - Smoker 

On examination 

Patient is conscious coherent co operative 

Oriented for time place and person 

Pallor ++

Icterus ++

No cyanosis 

Clubbing or lymphadenopathy 

Febrile : 99.9 

Bp: 130/80mmhg 

PR: 83 bpm regular normal volume 

Systemic examination :

CVS : s1s2 no murmurs 

Rs : NVBS + no crepts 

P/A: mild splenomegaly + BS + 

CNS : 

Tone :   Rt            Lt 

  UL       N              N 

  LL        N              N 

Power :  Rt            Lt 

    UL       5/5          5/5 

    LL        5/5           5/5

Reflexes : 

                B      S      T      A    K      P

Rt.           2+  2+   2+    2+    2+   F

Lt           2+  2+    2+  2+     2+    F

Sensory : 

Fine touch : present 

Crude touch : present 

Lost sensation over the hypopigmented lesion on lower limbs

Intact sensation over the lesions on forearm & neck 

(Touch , pain & temperature were intact over forearm & neck lesions

Lost pain & touch over lower limb lesions)

Diagnosis : 

?Wilson’s disease with Hansen’s 

?DRUG INDUCED HEPATITIS

Treatment given:

1.TAB.UDILIV 300 MG/PO/BD

2.TAB.RIFAXIMINE 550 MG/PO/BD

3.SYP.LACTULOSE 10ML/PO/TID

4.INJ.PANTOP 40 MG/IV/OD

5.INJ.ZOFER 4MG/IV/SOS

6.IVF NS AND RL @50 ML WITH 1 AMP OF OPTINEURON IV/OD

7.MONITOR VITALS 2ND HRLY