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Diagnosis case diary
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Provisional Diagnosis - Pt. under Cardiology Ref. to Med. (combined management). T2 DM (HTN), CAD, Gr. II AR & MR mild AS/ acute IE colonic diverticulosis, dropping hemoglobin level
Final Diagnosis - Hemolytic work up-ve. Except consistent micro-hematuria Serum iron/ferritin & B12 N., Advanced Echo-Aortic root abscess. FET-CT Scan, essentially N. vasculitis work up –ve. Anemia due to microangiopathic hemolytic anemia sec. to SBE & splenomegaly. Pt
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Provisional Diagnosis - Behcet’s syn. On steroids for >  & ½ yrs.(recurrent oral & genital ulcers.), steroid induced DM/HTN glaucoma/PVOD Ref. from GE Med. For steroid withdrawal
Final Diagnosis - Steroids were gradually stopped, with inj. ACTH (serum ACTH very low) weekly/addition of thalidomide & colchicines. Patient doing very well off steroids, steroid induced complications regressing
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Provisional Diagnosis -
Final Diagnosis - ? All cancer markers –ve. 1. Osteomalacia 2. Secondary Hyperparathyroidism Patient improving very well on vit.D, sachets & Ca. PTH returned tonear N./Vit.D level N.pt. A symptomatic  Rpt skeleral Scintigraphy 7/12/09-Significant reduction in the intensity and num. of Hot Spots in axial skeleton, Good response to Rx.
History and Findings - Severe bone pains & myalgia (Invest.) high ALP, N. GGT, PTH 1022/25 (OH), vit D 6.63, (very low) Ca, 8.5 urine Ca.: Cr. 0.05, skeletal scintigraphy 2/209 Metabolic bone disease-diffuse-skeletal Mets. MRI Neck-no e/o enhancing lesion in neck or supr. Mediastinum./ Stool OB/fat –ve. Thyroid FNAC N
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Provisional Diagnosis - ? PBC
Final Diagnosis - Lap. Laporotomy(GI surgery) & Open liver biopsy-No HPR no e/o granuloma/ malignancy  1.PBC  2. ? ILD (CT chest subpleural nodules)
History and Findings - Anemia/PUO/ dyspepsia wt.loss (Invest.), Hepato splenomegaly-exudative ascitis(-ve malignancy)-retroperitoneal L. nodes. High ESR, ALP & GGT/thrombo cytosis ANA-ve, AMA-ve, anti LKM-ve C&P ANCA-ve, Ferrin 1895, AFP-ve, OGD N., Colonoscopy N.,
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Provisional Diagnosis - ?168 pg/ACE N. Urine Ca.Cr.?0.3/RAneg, Doppler neck vessels N.skeletal scintigraphy N./Tc MIBI parathyroid-Rt. Infr. Parathyroid adenoma
Final Diagnosis - Hyper parathyroidism Parathyroid adenoma Ref.HNS Parathyroidectomy 2/2/09
History and Findings - Syncope/Bone pains/Joint pains/Myalgia Invest?Hypercalcemia, hypophosphatemia/PTH
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Provisional Diagnosis - Anemia and General weakness (invst)Hb.7.7 ESR 74. LDH 675, Reticulo cytosis ++, ANA+ve, ds DNA-ve, DCT & ICT +ve, sickling-ve, cold antibodies & cryoglobulins-ve, Urine hemosiderine-ve, Anti TPO 2003
Final Diagnosis - FNAC Thyroid-autoimmune thyroiditis Auto immune hemolytic anemia recovered on steroids/LT 4 & immuno suppressants.
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Provisional Diagnosis - Bone Pains Hyper Calcemia/Hypercalciuria ?ESR, Skeletal scentigraphy 7/1/09? extensive Skeletal mets FNAC Breast Lump 10/01/09 epethelial hyperplasia Excision biopsy 13/1/09 HPR 16/1/09 infiltrative duct Ca.breast
Final Diagnosis - Ref.Oncology Excision biopsy 13/01/09? infiltrative duct Ca. MBR Gr. II Surgery 22/1/09
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Provisional Diagnosis - Chr. Non productive cough for last 3 months following sandstorm(Gulf). No relief with various antibiotics/ steroids/inhalers from Gulf and KIMS Tvm. X 3 months h/o urethritis+Urine RBCs+ve/ Urine culture No growth ANA neg.P.Smear N
Final Diagnosis - C x R, HRCT chest:- one media stinal L. node (subcentimetric), Layer of fluid around liver (perihepatitis.) Mx. Just +ve/corrected ca.N./brucella IgM & Toxoplasma IgM neg./aspergilla skin test +ve. Aspergilla IgM+ve serum IgE Chlamydia IgM+ve ? Chlamydial urethritis/Fitz-Hugh-curtis syn./ABPA. Improved on clarithromycin/seroflo MDI/monteleukast x 2 wks.to be followed by Itraconosole x 6 wks
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Provisional Diagnosis - Kartagener’s syn./polycythemia vera/vascular head-ache/bipyramidal signs with N. cranial nerves
Final Diagnosis - MRI brain/screening C.spine.disc bulge C4/C5. brain N. improved on phlebotomy & Rx for sinusitis +bronchiectasis
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Provisional Diagnosis - Polyarthritis/Hypothyroidism/ESR? ALP?  proteinuria/P. neuropathy/S. protein EP neg.?2 microglobulin?  ANA/RA neg
Final Diagnosis - Skeletal Scintigraphy:- no bone lesions ? Sero neg.RA Amyloidosis AA hypothyroidism
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