A 75 year old male, farmer by occupation and a resident of Miryalaguda presented with chief complaint of lower backache, increased urine output and yellow coloured urine.

HOPI- The patient was apparently asymptomatic 5 years back then he had joint pains of both the knees and low back ache with difficulty in walking for 3 to 4 months with right knee joint swelling. Right knee joint was aspirated.

 6 days back he had Pain in lower back which is shooting type continuous and radiating to lower limbs(Pain was severe that he couldn't sit, so they went to a local hospital and got treated).

Pain was followed by fever which is Intermittent, and temperature increased at night and fever subsides by morning. Fever relieved on medication (Dolo).

There is also increased frequency of micturition around 15times in a day(18 times in one night), yellow coloured urine.

No H/o Nausea, vomiting, diarrhoea, headache, dizziness.

Past History - k/c/o DM and HTN since 5 years. Not a known case of TB, Asthma, Epilesy.

Personal History-

Diet- Mixed

Appetite - Normal

Sleep- adequate

Bowel- Normal

Bladder- Increased frequency of Micturition. 

Addictions - Smoker at 20 years of age

Smoked for 1 year(1 pack per day) and then he discontinued.

Family History - No significant family history 


On Examination -

Patient is conscious, coherent, cooperative.

No pallor , Icterus,clubbing, cyanosis , koilonychia, generalised lymphadenopathy.

No b/l pedal oedema

Oedema of left upper limb- present

VITALS 

Temp- Afebrile

Bp-120/70 mm hg

Pulse- 80bpm

RR-16cpm

RBS- 121 mg/dl

JVP- raised column of 7cm

Systemic Examination -

Cvs-S1 S2 +

RS- Shape of the chest- Barrel shaped

AP - 85 cms

Transverse - 30 cms

P/A - soft and non tender

CNS- 

No meningial signs

GCS:-

Pupils:-

Plantars:- Plantar extensora

Power -           Rt               Lt

Upper limb-  4/5            4/5

Lower limb-   4/5            4/5

Tone-

Upper limb-.  N.              N

Lower limb-.  N.              N

Reflexes:-.     Rt.               Lt

Biceps.          2+               2+

Triceps.        2+               2+

Wrist.           2+               2+

Knee.            2+               2+

Ankle.           2+               2+ 

Clinical Images











Investigations

USG-


X-Ray










Provisional Diagnosis -

Spondyloarthropathy

CKD secondary to DM

Diabetes 

Hypertension











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