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Raji R Panicker,28yrs/F 30/06/2011

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Provisional Diagnosis-Autoimmune Hepatitis AMA Neg,PBC Autoimmune Thyroiditis ?Reflux Nephropathy/early CRF
Final Diagnosis-Autoimmune Hepatitis/Cholangitis AMA Neg PBC/Vit D def Reflux Nephropathy/Early CRF Iron def anemia
History and Findings-Pain Rt Calf muscle & recurrent fever with chills x 1month One episode of UTI post partum 1 1/2 yrs back on 1/12/09 Culture E.coli USG abd 09/12/09-Contracted RK 5.8x 1,7cm size Compenastory hypertrophy LK 12.3x 3.4cm Multiple GB calculi 3-6mm(1/01/11) Arterial & venous doppler lower limbs 8/06/11-No DVT
Investigation-Hb-10.6,ESR-70,S.Creatinine-1.5 upto 1.9,Urine-10-15 WBCs,urine culture-No growth,uric acid-5-7mg upto 6mg,MP MF neg,CRP-79.20 upto 283.1,SGOT-82.6,SGPT-65.6,GGT-395.6,ALP-559.7,A/g-3.9/6.1,Na-135.4,K-4.3,urine Na-29.1,S.protein EP-No M Band,ANA +ve (1.64),AMA-Neg,C-ANCA,P-ANCA-Neg,ds-DNA-Neg(18),C-ANCA,P-ANCA-neg,Anti LKM-2.00 (Neg),C3-202,C4-51.86,iron-50.1,fe-148.06,EPO-16.3,IgG-2568.37(high),IgM-256.24,IgA-466,32,ANA profile-Neg,Cryoglobulins-Neg,25(OH)Vit D-10.95ng,stool OB x 3 -neg,Leptospira IgM-Neg,24hr urine protein-9mg,Echo-N study,Blood culture coagulase neg staph,whole body skeletal scintigram-31/10/11-No e/o Metabolin bone disease,DTPA renogram-6/07/11-Non functioning RK,LK GFR-37 ml/min,severe parenchymal disease RK,Moderate parenchymal dysfn LK,DMSA scan-6/-7/11-No DMSA uptake RK,loss of cortical volume in midcortex LK,size 13x5xcm,Lymphoscintigram B/l,no lymphatic obstruction,Micturating cysto urethrogram(MCV)10/07/11-no vascico-ureteric reflux could be observed.Urine AFB culture -no growth after 6wks Nephro opinion:reflux nephropathy with early CRF
Treatment-Inj.Linezolid for staph coagulase neg(Blood culture) along with montelukast/UDCA/LT4/Calcirol/Iron supplements with OD dose ofloxacin 200mg(from Nephro)
Follow Up-Repeat LKM1 antibody 09/12/11-borderline +ve.Pt improving on present line of Rx.Tissue diagnosis could not be done since pt is unwilling for liver biopsy
doctor bhaskaaran

doctor bhaskaaran

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