Hall ticket no.:1601006167

SHORT CASE:

35 year old gentleman hailing from Ramchandrapuram who is a daily wage labourer by occupation, presented with blackish discolouration of the skin over the hands and and feet with skin peeling, cracking, ulcer formation associated with burning sensation and erythema all over the body since 14 days.

He has a history of painless papules with erythema that started initially over the face then gradually extended to upper limb, low limbs and trunk 3 months ago.

• Patient got topical cream, soap and some oral drugs from nearby medical shop 
• He used them for 2 months, few lesions regressed but few persisted on nose, ear lobe, hands, legs and trunk.
• 14 days ago patient developed blackish discolouration of the skin over the hands and feet with skin peeling, cracking, ulcer formation associated with burning sensation and erythema all over the body.
• No new lesions were noted 

Since 4 days patient developed continuous high grade fever associated with chills and rigors.

PAST HISTORY:

History of painless papules with erythema that started initially over the face then gradually extended to upper limb, low limbs and trunk 3 months ago.

FAMILY HISTORY:

No similar complaints in the family

PERSONAL HISTORY:

• Loss of appetite
• Chronic smoker (1 pack of beedi every 2 days)
• Chronic alcoholic (90ml daily) since 20 years

EXAMINATION:

• Face: loss of eyebrows(madarosis) and thickened earlobe
• Oral cavity: dark erythematous lesions on the palate
• Multiple papules with erythema all over the face, limbs and trunk 

Provisional Diagnosis:

Based on the above findings my provisional diagnosis is LEPROSY.