### 45 years old Muslim housewife got admitted with the complaints of joint pain for 2 & 1/2 years. Associated with generalised purpuric & non blanching rash for 3 days which is more on both lower limbs & upper limbs. H/o mild fever for last 3 days associated with oral ulcer. Known case of IHD, COPD & Hypothyroidism. What's your D/Dx ??? What's your Dx ??? What are the investigation that you will do ??? How will you treat the patient ???

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@Dr. Shofique Anowar Fever + Rash (Palpable) + Joint pain + Acute in onset ....... most probablity is HSP with closest DD being DISSEMINATED GONOCOCCAL INFECTION. R/O other DDs : 1. PPP : More chronic 2. ITP :Non palpable, Afebrile 3. Autoimmune Vasculitis : Palpable but usually Afebrile. 4. TTP, DIC, Purpura fulminans : Febrile but non palpable. 5. Rocky Mountain Spotted Fever : Palpable and febrile but usually seen in distal limb (palm, wrist, ankle, Sole),Joint pain less likely. 6. Endocarditis : Palpable and Febrile but associated with cardiac symptoms, Eye involvement etc. 7. Meningococcemia : Palpable and Febrile but associed with other symptoms of DIC and meningitis. Primary investigations needed : BT, PT, APTT, CBC. Echocardiography (if new onset cardiac symptoms only). Gonococcal tests

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IT'S A CASE OF.. * VASCULOPATHY.. * IMMUNE THROMBOCYTOPNIA.. * ITP.. .. MAYBE DRUG INDUCED .. .. WITH.. IHD ,COPD , HYPOTHYROIDISM.. NEED'S CLINICOPATHOLOGICALLY EVALUATION WITH.. BLOOD CBC CT BT PT.. URINE ROUTINE.. BSR , HBA1C .. LFT,& KFT.. COLOUR DOPLER STUDY.. AND.. INVESTIGATIONS FOR ..IHD, COPD & THYROID..

Tnx a lot Dr Yashwant Mashankar
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COULD BE RHEUMATOID ARTHRITIS WITH INCIDENTAL DENGUE LIKE FEVER . INVESTIGATE ON THOSE LINES. MORE SINISTER DIAGNOSIS WILL BE HENOCH SHONLEIN PURPURA CHECK FOR HYPERTENSION AND RENAL FUNCTION RENAL BIOPSY TO CONFIRM DIAGNOSIS

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Purpurial rash, since a moderately I'll pt, must be treated in a modern Hospital by group of specialists combined

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H. S. P.?? THROMBOCYTOPENIC PURPURIAL. RASHES VASCULOPATHY NEEDS FURTHER INVESTIGATIONS

By seeing rashes, it suggest HSP Do cbc esr BT CT RA factor , Renal function test D/d Renal dysfunction

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Assalam u alykum. Very good possibility. I congratulate you. DR ABDUL MAJEED top opinion leader

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Possibility of vasculopathy or autoimmune disorder... Adv ANA and other basic investigations...

I think its a case of Psoriatic arthritis and the skin lesions shown can be erythroderma

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Rash is associated with fever, kindly do cbc, NS1 antigen, dengue serology .

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