The 28 yr female ,has compliant of pain in abdomen since last 2 year. Pain is associated with continuous sensation of nausea , no vomiting . Last two she has gone to the best centres of gastro in Ahmedabad, mumbai & Hyderabad . Underwent upper G I Scopy , colonoscopy and biopsy and Usg abdomen and CT abdomen three times. All these test did not conclude any diagnosis. Work up for Crohn’s was non conclusive . Antacid ,antiemetics and
messaline trails fail to improve her condition.
Last 6 month pain has increased so much that it, it affected her sleep and appetite.
Came to me for diagnostics work up 4 days ago. After analysing all her reports, findings were – generalised abdominal tenderness, eosinophils 5-6%, weight loss 4 kg.
So one of the most exciting case for me to find out the cause – Case was diffuse tenderness , eosinophilia and raised CRP.
DD WAS – AUTOIMMUNE PERITONITIS, OCCULT TB-( CHRONIC PERITINEAL SEROSITIS), VASCULITIS, GLUTEN INTELORANCE, IBD( CROHNS) AND PRIMARY ADDISSON DISEASE.
INVESTIGATION REVEALED – 6 am cortisol 2 ( VERY LOW), ACTH ( 49-HIGH ).
PATIENT DID MENTION – EXCESSIVE TIREDNESS, FASCIAL PIGMENTATION AND MOOD SWING.
And then miracles happened – 20 mg wysolone – and patient was relived of her pain of 2 years.
Fairly preserved Sort ACTH test shows that patient will need very low dose steroid for life time.
