69M lawyer with tip of the toe, digital infarct and past history of external Iliac artery stent as well as rheumatoid arthritis.



E-LOGS MEDICINE 


Hi, I am Arefin Sadat, a final-year MBBS student. This is an E-Log that depicts the patient-centred approach to learning medicine. This E-Log has been created after taking consent from the patient and their relatives. The links that were used by me for understanding the available data on the particular disease have been mentioned below in each post. I hope you learn valuable information after giving it a good read.



CASE OF A 69-YEAR-OLD MALE


This is a case of a 69-year-old male who is a lawyer in profession. This de-identified blog was created after taking informed consent from the patient.


CHIEF COMPLAINTS

  1. Joint pain for 3 years
  2. Redness and pain in tip of the toe for 3 months


History of Presenting Illness



The patient was reasonably well till 2015.

Then he developed abdoninal pain which remained for almost 3 years.


In 2018, he did cholecystectomy at the same time he was diagnosed with pancreatitis and after using stent for one month, his pain due to pancreatitis removed.


Also, his angiography report reveals a blood clot in his left leg and external Iliac artery stent was done.


Later in 2020, he developed joint pain and diagnosed with rheumatoid arthritis and didn’t take any medicine. The pain occurs twice a month and usually stays at night.


In 2021, his creatine level increased to 1.9 mg/dl which after taking medicine for 1 year reduced to 1.7 mg/dl.


On November 2022, his tip of toe become painful and reddish in appearance. Fungal test was negative. Currently he is taking a moisture and ointment but no improvement is seen. Pain elevated when he used to walk or wear shoes.


Currently he is taking 

1)Aztor 10

2) Asomex 5

3)Telma  40

4) ketograce DS

5)Saaz



History of Past Illness


No significant past history.


Family History 


His mother was a known case of diabetes.


Patient's Diet 


-Breakfast: roti, vegetables, sweet

-Lunch: rice, fish/chicken,vegetable

-Dinner: roti, vegetable



Personal History  :


Weight - 58 kg

Appetite - Decreased

Bowel- Normal

Bladder movements - Normal

Addiction - Chain smoker for almost 15 years but currently trying to decrease the habit.

No alcohol history.



Clinical Images: 














Investigation: 
























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