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Diagnosis case diary
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Provisional Diagnosis - ? Multiple Myeloma ?Bone Mets
Final Diagnosis - Multiple Myeloma IgG
History and Findings -

T2DM/SHTN/DLP/Presented with LBA of 6months to GVR saturday clinic on 23/4/11.Review with investigation on 30/3/11

Paraproteinemia/Abnormal band in gamma region on EP/very high ESR/A/g reversl/hyperuricemia/Hypercalcemia/anemia & proteinuria

P.Smear on 2/5/11-Rouleaux +

BM study-Aspiration 40% plasma cells

Biopsy-cellular marrow with sheets of plasma cells s/o M Myeloma

IgG-6827.7,IgA-37.29,IgM-29.28,Beta 2 microglobulin-8.99

Kappa 70.8,Lambda-5.9(ratio-13.88)

Case of IgG myeloma referred to oncology on 2/5/11


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Provisional Diagnosis -
Final Diagnosis - ? Papillary Ca thyroid Ref. HNS on 23/12/09/Exam case
1.Re-evaluation slides here same diagnosis. Total Thyroidectomy on 4/1/10 HPR : 7/1/10, Lt. lobe- micropapillary Ca. Rt. Lobe lymphocytic thyroiditis
History and Findings - Tyroid Nodule evaluation done by me at Guruvayur OPD (Saturday) 12/12/09. TFT N., USG thyroid- hypoechoeic Nodule Lt. lobe thyroid FNAC Papillary Ca thyroid
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Provisional Diagnosis - ? Parietal wall swelling ? heamatoma to r/o malignancy
Final Diagnosis - Ref. to GI surgery on 16/12/09, Excision biopsy on 9/1/2010, s/o. malignant spindle cell neoplasm (Neural Sheath tumour)
History and Findings - Pain & swelling RIF since 2004, O/E form mass felt in RIF, tender on deep palpation.
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Provisional Diagnosis - Recurrent polyarthritis 11 years, pain calf muscles on exertion 7/12 subcutaneous swellings 5/12, DOE cl-II 7/12, LBA mainly SI joints Lt. > Rt. 7/12, On Rx, from Banglore with sazo/ pregalin 75/indomethacin SR 75, Inj. Depomedrol weekly.
Final Diagnosis - 1. Rheumaticarthritis(no Carditis), (Polyarthritis, S/C swellings, ASO +ve, ADNB ab, ++Echo aortic valve thickening, high ESR & CRP) 2. vit.D def.state: Pt. on steroids/Kaypen 500 bd./vit. D sachets weekly x 6 wkds. And omeprazole. Pt. improving, for review on 9/1/10 CRP 9.96 Hb 12.5 Urine Nil. ASO 200. ? Auto-immune syn involving Skin/joints & heart following Gr. A streptococcal infection (No CNS involvement/ No carditis)
History and Findings -
Investigation - ESR 40, CRP 15.39, RA ANA & ds DNA-ve,ASO +ve 200 u. APLA IgM & IgG-ve homocystein 8.4, (N) anti DNA seab?? 591. MRI LS spine (N) Echo aortic valve thickening, EF 60%, skin biopsy fibrocollagenous tissue. (No inflammation) OGD & colonoscopy N. ASCA-IgA & t Tg-IgA-ve, CI Esterase inh.15 ng(N), 25 (OH) vit.D.,? 11.16 NCV N.Ca/PN HLA B 27 neg
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Provisional Diagnosis-h/o polyarthritis since 2000 Jan. from Calicut MCH (being employed at Calicut) with show response Pt. shifted to Ayurvedic Rx. Till 2009 with only partial relief.
Final Diagnosis-? 1. Active RA 2.DVT +APLA syn. 3.? Auto immune hepatitis to be confirmed by liver biopsy. Pt. is on warf/Udiliv/HCQS.
History and Findings-
Investigation- Hb 13.8, ESR 38, CRP 2.66, RA ++256 u., ANA +ve 1.82, SGOT 60, SGPT 77.8, GGT 62.3, ALP 167.2, Plat. 476.00, A/G 3.9:4.1 APLA-IgM 69.4., IgG-ve, 3.15, Venous Doppler lower limbs Tvm. MCH-DVT Lt. leg. Arterial Doppler lower limbs N. Anti LKM & AMA –ve, ds DNA-ve, C3 & C4 N., ANA profile-anti sm ab. +ve, anti Nukleosomen +ve, PT with INR 0.94, USG abd. Altered liver echotexture(CLD)
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Provisional Diagnosis-Polyarthralgia/recurrent fever/dyspepsia/alopecia since 2005, diagnosed as SLE from MIMS Calicut Oct.2007 on Omnacortil/ HCQS/for second opinion.
Final Diagnosis-? 1) systemic sclerosis MCTD with Sicca syn. 2.Thyroidits Rx. On tapering steroids/HCQS & LT4
History and Findings-
Investigation- MNG, FNAC, Thyroiditis, 2/12/09, ANA +ve, 20.30,ds DNA-ve, ANA profile – anti Scl. 70 +++,RO 52++, SS-A +++, RNP +++, RA & ASO –ve, ESR 40, C3 &C4 N
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Provisional Diagnosis - OS-ASD L-R shunt for ASD device closure
Final Diagnosis - Ref to pediatric cardiology, ASD closure on 2/12/09
History and Findings -
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Provisional Diagnosis -
Final Diagnosis - IgG myeloma On Rx. From med. Oncology
History and Findings - Ref. from Holistic med. (AIMS) bone pains invest. Skeletal Scindigraphy 3/11/09 N.study. HRCT chest 4/11/09 N. study, BM study – cellular marrow with plasmacytosis 10%, kappa & lambda light chains both high (k 53.8, la.42.2) Serum immunoglobulins-IgG 2024. IgM 227, IgA 882.
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Provisional Diagnosis -
Final Diagnosis - 1.? multiple myeloma
2. CIN/early CRF (chr. Intersttial nephritis) BM syudy & light chains screen deferred due to old age & severe osteoporosis.
3. Inj. PTH was stopped on nephro referral.
History and Findings - k/c/o severe osteoporosis on Rx. Inj Teraparatide(Ortho AIMS) presented with bone pains mild CRF/ proteinuria/microhematuria/hperuricemia/A/G reversal/& high ESR ? multiple myeloma skeletal Scintigraphy 23/10/09 no e/o skeletal mets/DTPA renogram-Lt kidney GFR 16/ Rt 24 / kidney size Lt. 7.6cm Rt. 7.3 cm., serum protein EP no M.band,
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Provisional Diagnosis - ? 1)Marfan,s syn.
2)Secondum ASD with L-R shunt
Final Diagnosis - Ref to ped. Cardiology. Seen on 21/10/09 for ASD- device closure on appointment
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