Question

Description

Mr. Bryan is a 29-year-old married man who came to the medical office because, over the last three years, he has progressively increased the size of his shoes, and he has resized his wedding ring three times. He says his feet and hands have grown. He has also noticed that his face has turned coarse. He was a very active man and practiced sports, but now he fatigues just by walking, and feels weakness in his muscles and stiffness in his joints. He is depressed because in the last few months he has been experiencing erectile dysfunction, which is affecting his relationship with his wife. He feels he is losing his vision as well.

Mr. Bryan does not drink alcohol, smoke, or use any recreational drug. His mother suffers from diabetes mellitus type II, and his father suffers from hypertension.

On physical examination we found:

Remarkable Signs

• Head: Enlarged and coarsened facial features, prominent superciliary arches, prognathism
• Neck: Thyroid is visible and palpable
• Thorax: Barrel appearance
• Abdomen: Hepatomegaly. Splenomegaly.
• SOMA: Enlargement of the hands and feet. Generalized arthralgia.

Remarkable Signs

• Integumentary system: Thick and oily skin. Numerous acrochorda disseminated throughout the body.
• Cardiovascular system: Blood pressure 150/100. Radial pulse 72.
• Digestive system: Megaloglossia. Diastema.

Answer the following

1. What are some chronic inflammatory disorders that we have to take into account in a patient who has thick skin?

2. Mr. Bryan is complaining of stiffness and pain in his joints. What do you know about arthritis?

Answer 1

Most common Chronic inflammatory disorders in a person who has thick skin :

-atopic dermatitis

-psoriasis

Psoriasis -it is a chronic inflammatory disease in a person with thick skin. It is a skin disorder which causes skin cells to multiply up to 10 times faster than normal skin. It causes scaly red patch, most commonly seen on knees, elbow, trunk and scalp.

Atopic dermatitis -an chronic itchy inflammation of skin. It is very common to children but can occur at any age. Most commonly seen in people with family history of disease.

Arthritis

Arthritis is the inflammation of one or more joints, causing pain and stiffness that can worsen with the age.

Symptoms-joint pain, stiffness, swelling, range of motion decreases and skin becomes red.

Diagnosis-x-ray, MRI, CT scan. Also blood test to check for antibodies like rheumatoid factor, antinuclear antibodies.

Treatment -analgesics, NSAIDs, immunosuppressants. Also surgery and physiotherapy.