A 9 year old girl had developed fever which was high grade associated with joint swellings. She states that all her joints we're swollen small and large joints of both the limbs. She had complaints of generalised weakness for the next 3 months. She was married at the age of 13 years. Even till this age she had the previous complaints of joint swellings. Her husband tells that her joints used to swell intermittently whenever she works and that she always was lethargic and weak.


4 years back she developed blisters on the arms and legs which were filled with fluid and pruritic.. These lesions were sudden in onset preceeded by burning sensation followed by itching sensation. She also had complaints of generalised weakness so much so that she could not get up. This weakness was associated with tingling sensation of the limbs and spasmodic contractions of the muscles. She was diagnosed to be hypocalcemic and was treated accordingly. The husband gives history of skin biopsy but no documentation could be found. The lesions when she had lasted for 10-15 days and used to occur once every 6 months. No h/o contact with any thing which could be correlated with the lesions.



         This time she has presented with the same complaints of generalised weakness and spasmodic contractions and tingling sensation. Whenever she has the contraction episodes she is not able to speak as she tells she is not able to move her tongue to speak. Gives history of irregular bowel habits once in 3-4 days.

         The lady is currently 32 year old female.



COMPLETE BLOOD PICTURE
HB-12.5Gm%
TLC-9,600
N-63
L-31
PCV-40.2
MCV-78.8
PLT-3.93 lakhs/cumm
Peripheral smear-
Normocytic normochromic.

RFT
Urea- 33mg/dl
Creatinine-1.2 mg/dl
Uric acid- 6.3 mg/dl
Calcium-10.5mg/dl
Phosphorus- 2.3 mg/dl
Sodium-147mmol/L
Phosphorus-2.9mmol/L
Chloride-104

Serum magnesium- 1mg/dl

THYROID PROFILE
T3- 0.97
T4- 11.69
TSH-3.39

LFT
TB-0.51
DB-0.22
SGOT-25
SGPT-16
ALKP-103
Tp-6.3
Alb- 3.5
A/G-1.25

After the correction of potassium
Serum potassium-3.8

A dermatology opinion was taken where they had given a provisional diagnosis of dermatitis herpetiformis.

HER ACTIVE LESIONS:












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