國泰馬偕聯合病例討論會 Ｒ郭馨仁 Ｖｓ吳志仁

Basic datas Name: 蔡ｘ峯 Age: 61 y/o Sex: female Chart no: Date of admission: Date of renal biopsy: ( 亞東 ) Underline disease: hyperlipidemia, DM, HTN, VHD, hyperlipidemia

Chief complaint mild lower limbs pitting edema, right ankle pain with skin rash for 10 days

Present illness DM for 10 years with regular treatment The bilateral lower leg pitting edema with joint tenderness over right ankle for 10 days Visited the 亞東 DERMA ward and transferred to AIR OPD ( )  uveitis, arthralgia  R/O vasculitis  medication: chlorzoxazone, salazopyrin, sulindac  Some lower leg skin rash after taking 2 doses of the medications Admitted in 亞東 hospital

Present illness There were no malar rash, no haemoptysis, no neck mass, no neck stiffness, no dyspnea, no chest pain, no ecchymosis or fever condition, no tarry stool condition. There were no nausea, vomiting, no decreased urine output condition, Bilateral pleural effusion  CT scan: iniflammation, transadate pleural effusion Impaired renal function  renal Bx s/p solumetrol 40 mg v Q8h due to the vasculitis condition was considered Admitted in our AIR ward after discharge from the 亞東 hospital

Past and personal history No smoking, no drinking, no drug abuse, or Chinese herb using history Allergy; denied Family history: denied Medication history: Euglucon 2# BID, avandia 1# QD, metformine 1# BID, glucobay 1# TI, concor ½ # QD, bokey 1# QD,

Physical examination TPR: BT: 36, PR: 80, RR: 16, BP: 150/80 HEENT: mild pale conjunctiva, no icteric sclera, no JVE Chest: symmetric expansion, clear BS, basal rales HEENT: RHB, without murmur Abdomen: soft, hypoative BS, no localized tenderness, no rebounding pain, no palpable liver or spleen, no knocking pain Extremity: mild lower leg pitting edema with some skin rash

Lab data: urine routine PHSGWBCRBCproteingluc ose 97/11/ 9 ( 亞 東） /11/ : urine protein/ creat: 398/30.7 = 13

Lab data Bun/creat N/Kglucos AlbCholTGUric acid 97/11/13 66/ /11/14 58/ / /11/15 60/3.2142/ /11/19 72/4.1140/3.1

Lab data : 97/11 Ig G1150 ( ) HCV Ab negative IgA381 (82-453) HBSAgnegative IgM57 (46-304) ANCA c/p negative IgExx ( ) C3124 (79-152) ANAnegativeC424 (16-38) Anti-DS- DNA negativeAnti-SMnegative Anti-SSAnegativeAnti-RNPnegative Anti-SSBnegativeAnti- mitochontrial negative HLA-B 27 : negative （但在亞東醫院 positive ）

Lab data WBCHbPT-INRAPTT 97/11/ /11/ Stool OB : negative Cryoglobulin: negative Rheumatoid factor: negative Lupus anticoagulant: negative Anti-cardiolipin: negative

Kidney ultrasound: normal CXR normal kidney size