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Solve the case to win a giveaway from Dr. Rohini Handa

M3 India Newsdesk Oct 06, 2021

In this case challenge, Dr Rohini Handa presents a new case open for interpretation. Here, he describes a patient reporting with arthralgias and skin rash, findings from physical examinations and investigations and quizzes doctors on diagnosis and strategies that can be used to treat the patient.

Here's an exciting twist! Two lucky doctors who provide all the right answers will win a signed copy of Dr Rohini Handa's latest book: Clinical Rheumatology. *

Please note that the responses time window for this challenge has closed. The right answers to this case challenge will be provided by Dr. Rohini Handa within a week's time. Stay tuned for the next part of the case challenge!

Purpura in a 41-year-old lady- How to approach in the clinic?

Mrs MD, a 41-year-old lady, was referred with complaints of arthralgias and intermittent skin rash for 8-9 years. The rash was non-itchy and usually occurred on the legs and thighs (check figure). The arms and face were spared.

Prolonged standing in the kitchen aggravated the rash. There was no history of fever, weight loss, or anorexia. The patient denied any bleeding from the nose, mouth, ears or excessive bleeding during her periods. She was normotensive and non-diabetic. Physical examination was unremarkable except for palpable purpura on her legs (check figure). Heart/Chest NAD. No organomegaly was appreciated on abdominal examination. The joint examination did not reveal any synovitis or deformities.

Laboratory investigations available:

  • Hb. 11 g/dl, TLC 5100 [Polys 63%, Lymphocytes 33%, Monocytes 3%, Eosinophils 1%]
  • Platelets 230000
  • ESR 95
  • LFT: ALT/AST 31/25
  • TSP/A/G 8.1/4.2/3.9
  • Creatinine 0.6
  • Urine NAD
  • TSH 4.75
  • RF positive 81.4 (<12)
  • Anti-CCP negative
  • ANA positive 1:3200




Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Rohini Handa is a Senior Consultant Rheumatologist from Delhi.


*The lucky winners of this case challenge will receive their copies of Clinical Rheumatology within 4-6 weeks.

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