painful skin lesions in upper and lower limbs with polyarthritis



This is an online E-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome. 

I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.  

CONSENT AND DE-IDENTIFICATION : 
The patient and the attenders have been adequately informed about this documentation and privacy of the patient is being entirely conserved. No identifiers shall be revealed throughout the piece of work whatsoever.
A patient aged 35 yrs old ( married) 
Occupation: labour work 
Chief complaint: 
Patient presented with swelling and painful sores in arm , legs, fingers and at the region of chest 
History of present illness:
Patient was apparently asymptomatic 2 months back and then developed painful skin lesions over bilateral legs ,arms, back 
Bilateral skin lesions with pain and discharge
Regular dressings were done
H/ o fever since 4 days with no chills and rigor and it was relieved by medication
H/o burning micturition since 4days 
Decreased urine output
H/ o vesicles(+)
H/o pus discharge (+)
Deformity in hands,toe, fingers (+)
Past history 
No similar complaints in the past 
Negative history
No c/o sob/ orthopnea/palpations
Not a k/c/o thyroid disorders/ DM/ asthma /TB


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