A 18yr old male with multiple hyperpigmented patches

 A 18yr old male patient presented to the Opd with chief complaints of purple stretch marks all over abdomen, lower back, b/l lower limbs, b/l upper limbs since 2 years

No itching, burning sensation, pain

History of presenting illness

Patient was apparently asymptomatic 2 and 1/2 years ago then he developed round annular itchy lesions on lower back which spread all over the abdomen, groin, b/l upper limbs, b/l lower limbs for which he visited local doctor where he prescribed ayurvedic medication, ointment and tablets (unknown composition). 
Patient used the medication for 2 months the lesions reduced a bit
Later 2 months the patient got multiple hyperpigmented plaques all over abdomen,lower back, b/l upper limbs, b/l lower limbs associated with dizziness, tiredness, inadequate sleep, increased weight of 30kgs for which he again visited the same doctor who prescribed ayurvedic oil and CLOBETASOL ointment for the lesions for 1yr

History of past illness 

N/c/o DM HTN CAD ASTHMA TB epilepsy

Personal history 

Normal appetite 
Mixed diet
Adequate sleep 
Normal bowel and bladder movements 
No addictions

Family history 

Not significant 

General examination 

No Pallor icterus cyanosis clubbing lymphadenopathy pedal edema

Vitals

BP 110/60 mmhg
PR 72bpm
SpO2 98%
Afebrile temperature 

Systemic examination 

CVS system
No thrills
Cardiac sounds are heard
No cardiac murmurs

Respiratory system
No dyspnoea 
No wheeze
Trachea is centrally positioned 
Vesicular breath sounds

Abdomen 
Scaphoid shape abdomen 
No tenderness, palpable mass
Normal hernial orifices

CNS
Conscious 
Intact cranial nerves

Provisional diagnosis

Iatrogenic cushing's syndrome 










Treatment 

Tab Hisone 5mg
BP monitoring 1hrly


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