Medical case study assignment

Michelle Craig.

Ms. Craig lupus nephritis diagnosis with symptoms of the Grave’s disease

Propylthiouracil-induced lupus

Abstract:

Objective: to provide a description of lupus nephritis diagnosis with symptoms of the Grave’s disease case relating to complicated with hypothyroidism and anemia.

Design: Patient case report

Setting: Medical school center.

Patient: Ms. Michelle Craig is a 35-year-old who was diagnosed three years ago with lupus nephritis disease after developing symptoms that proved to be caused by Graves’s disease. She had propylthiouracil prescription for treating Graves’ diseases and after 16 months the disease was gone. During that time, she developed anemia, and this prompted the need to prescribe her with an alternative treatment therapy for hyperthyroidism. PTU was attributed to exacerbate the anemia and to depress her marrow.

Ms. Craig undertook, and a radioactive iodine uptake evaluation and that gave results that iodine absorption in her thyroid glands was 100%. She received the radioactive iodine therapeutic dose that corrected her thyroid hormone to the reference range. She suffered the common radioactive iodine therapy complication by becoming hypothyroid due to the excessive destruction to the thyroid disease from the treatment. The laboratory results for Ms. Craig showed that she developed the hypothyroidism three months after starting the iodine therapy. She is currently receiving treatments to correct the hypothyroidism using Synthroid

Case history:

Ms. Craig is a 35-year-old, right-handed, black American lady who visited the emergency department complaining of numbness of the face and right arm, with double vision. The system has lasted for more than 26 hours. Recently she had been diagnosed with hyperthyroidism and treated with propylthiouracil three times a day of the 150mg tablet. Three years ago Ms. Craig was diagnosed with Grave disease that was causing lupus nephritis treatment was with the anti-thyroid drugs the radioactive iodine.

She was later retreated with radioactive iodine a week ago. Her visit to the primary care provider was because of the gradual onset of anxiety, heart pounding feeling, anxiety, and fatigue. The physician did not find something remarkable in the physical examinations, but CBC showed anemia. She has a history of intermittent swelling and pain in her hands and pain on her wrists and elbows. She also admits to feeling tired and cold and dryness of her skin and hair. She complains of weaknesses and progressive dyspnea for a month now.

In 1999, the patient was diagnosed with hypertension and she has been taking medication three times a day. He also has a past hypertensive coronary artery disease with cerebral- vascular insufficiency angina pectoris and in eminent claudication. Five months before admissions she did not experience dyspnea or chest pain. She felt well. Her blood pressure was 196/77 mm Hg. She had visited the outpatient clinic two months earlier, she was well but had complications of dizziness and blurred vision. On the day of admission, she looks quite pale and icteric. Her blood hemoglobin level is at 7.7 gm/100ml. The stool guaiac test was negative. She reported not to feel night sweats, chills, fever, weight loss or anorexia.

After eating small quantities of food, she experiences fullness. She reports that she had not yet had any blood loss from any orifice. She denies having paresthesias, pain, in muscles and bone, joint symptoms, ataxia, and glossitis. Medical history and systems review were noncontributory. However, family history provides compiling evidence showing the patient’s genetic predisposition. In the past, she had a possible allergic to tetracycline hydrochloride characterized by possible pyoderma and dermatitis.

Physical examination showed pale, acutely icetrucmobeses and dyspneic woman. Her blood pressure was 196/77 mm Hg. with a pulse rate of eighty-eight beats per minute, temperature, 99.6F (37.6 C), respiration was 30/min. Her tongue was also well palpitated. Her lungs were clear to percussion and auscultation. Lab report also showed no perusable cardiomegaly. a low-grade frequency of 3/6 systolic murmur was noticeable. One could hear the beats from the left infraclavicular and sternal border area an ejection quality. The spleen and liver were also not palpable. A peripheral edema was not available and no ecchymosed or petechiae. The vibration and position sense were normal. She was also anemic on admission (Hb, 10g/100ml). Chest X-ray shows areas of fluctuations of pleural effusion and atelectasis trapped in one location (Valdivia, 2011).

The laboratory studies indicated the following values hemoglobin, 7.7 gm/100 ml: red blood cells, 2, 1600.000/cu mm; white blood cells (WBS) 7,700/ mm with hematocrit, 23%, 37% lymphocytes, 52% neutrophils 4% eosinophils, 7% monocytes. the morphology for RBC showed many spherocytes, 3+ polychromatophilia, few Howell-Jolly bodies and nucleated RBCs. There was a 16.8% in reticulocyte count and the 464,000/cu mm for platelet count. there were 920 units on lactic dehydrogenase; total serum bilirubin was three mg/100 ml, an iron serum of 315g and the uric acid level; at 10.6 mg/ 100 ml.

Conclusion

The manifestation of Hematology was the common manifestation for the thus patient. Hemolytic anemia, thrombocytopenia, antiphospholipid antibody syndrome were the common presentation of the lab test results. The common hematological abnormality drug the entire course of the disease was a multi-factorial anemia. There was no any significant association with lupus with the hematological manifestations. The ACR criteria do not include the autoimmune hypothyroid's which are a common coexisting abnormality among patients with the initial manifestation of the hematology.

A significant number of patients do not fulfill the ACR criteria for the whole diagnosis but through follow-ups, they can do so. The proposal is for new criteria that can manage to diagnose the SLE early. For instance Antiphospholipid antibodies as well as lupus anticoagulant has to be checked in patients with lupus since they associate with APLS. Other investigations can be used depending on the involvement system such as renal biopsy, echocardiogram, and MRI brain scan. Women suffering from SLE have a high risk of atherosclerosis at a premature level, and the risk is independent of cardiovascular risk factors establishment. Thus, it is cruel to monitor all the risk factors. Patients will also need considerable counseling concerning their individual symptoms and prognosis. They should treat and identify the underlying cause (Pyne and Isenberg, 2012).

References

Pyne D, Isenberg D (2012). Autoimmune thyroid diseases in systemic lupus erythematosus. Ann Rheum Dis. 2002;61:70-

Valdivia, P (2011) Lupus, Graves' disease, and vasculitis: a case report. Mar;59(3):222-4. doi: 10.1016/j.endonu.2011.09.010. Epub 2011 Dec 11.

Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in research paper writing help 24 hours if you need a similar paper you can place your order for essay writing services.

"Janet Peter is the Managing Director of a globally competitive essay writing company.