60 YRS OLD MALE WITH REPEATED BOUTS OF SNEEZING AND ITCHING OVER BODY

Unit posting (Intern 2017)

Medical Ward

GM II

Dr Nikitha

Dr Hari Priya

Dr Govardini

Dr Sneha

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Patient came with chief complaints running nose, repeated bouts of sneezing since 2-3 months along with itching all over the body since 1 year.

HISTORY OF PRESENTING ILLNESS:

Patient was apparently asymptomatic 1 year ago, then he developed

- itching all over the body that was insidious in onset, gradually progressing and intermittent in nature since 1 year associated with scaly lesions over both the lower limbs, namely the shins.

- usually aggravated on eating fish of any kind. No relieving factors as such.

- Patient had complaints of running nose and repeated bouts of sneezing since 2-3 months, that was sudden in onset, gradually progressing and usually aggravated during seasonal change. Usually subsides on its own.

DAILY ROUTINE-

Patient is a cotton farmer by occupation, and lives with his wife, his son and daughter in law. His daily life consists of waking up at around 7:00, stretching to help with his mobility, brushing his teeth, having a cup of tea and leaving for work usually taking from home two packed lunches.

He doesn’t usually consume breakfast, rather he consumes two lunches. He goes to work by 8-8:30 and starts with the cotton field work which includes spraying pesticides (the only protective gear he wears are his slippers) along with ploughing etc.

He’ll have his first lunch by 10:30 AM which consists of a good portion of rice (almost 2 big serving spoons worth) along with any vegetable curries and some pickle powder. He’ll have the same meal usually for his second lunch by 1PM along with some co-workers where they usually share and exchange their meals. Then resumes work in between the breaks and after. Usually finishing by 5pm.

He goes home straight after work, washes up and socializes for a few minutes with his neighbors then comes back home for dinner with his family usually prepared by his daughter in law. Then watches some tv with the family and goes to bed by 10PM, usually un-disturbed sound sleep of about 8 hrs.

Patient occasionally consumes alcohol namely Toddy during festivities or functions but doesn’t have any other such habits and indulges in non vegetarian items maximum twice a week but was found to have itching aggravated on consuming fish of any kind, so has reduced consuming fish and goes more for chicken and eggs. Has no other bowel and bladder complaints.

PAST HISTORY-

- no similar complaints in the past

- no history of HTN, DM, CVA, CAD, TB, Epilepsy

ALLERGIC HISTORY-

- Alleged known allergic to fish of any kind so has reduced its consumption

GENERAL PHYSICAL EXAMINATION-

- Patient is conscious, coherent, and co-operative.

- No s/o pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema