                                                                       Apollo                                                                 1066
    Dr. RAM GOPALAKRISHNAN -                                                Smtpavent Summary and Prescription
                                                                                                                                           Saving time. Sewing heves
    INF.DIS
    MD.MRCP (UK) ,AB (Int,Med)
    AB (Infectious Disease),
   INFECTIOUS DISEASES

    Mr. NARENDRAN P                                             UHID : FMH1.0000011612
   Male, DOB : 10-NOV-1988(34Y 9M 6D)                         OP Number - Visit ID : OP8363052-1 Visit Date : 16-Aug-2023
   Address : NO 55, ELEPHANT GATE STREET Chennai Chennai Tamil Nadu India
   Phone : 91-9840107048


   Allergy :- No Known Allergy

   CHIEF COMPLAINTS
       Ref from Dr G Ravichandran (dermatology)
       From Chennai, IT employee, no comorbids, married
       No prior TB, H/o pulmonary TB in cousin sister diagnosed 10 months prior, exposed to her
     prior to diagnosis, father had AML diagnosed in june 2020, expired may.22 due to illness.
     no recent surgeries

  HISTORY OF PRESENT ILLNESS
     H/o generalized erythematous itchy rashes in july 22, evaluated at dermat, diagnosed as
    urticaria, treated with anti histamines, settled then. Then in jan.23 had fever, with pt. noticed
    painful/tender lesions under the skin at random places, treated with antibiotics (ceftum for
     5days) and prednisone 10mg for 5days, fever and lesions settled. Again had recurrence of
    lesions with no fever and no constitutional symptoms, evaluated elsewhere 15.5.23 CBC
     13.6. 7500, 2.5L DC normal, ESR 11, ALT 25. RA factor -ve, CRP -ve, Anti CCP -ve, ACE
    levels normal, HLA B27 -ve, ANA profile -ve. Lesions settled on own, but again recurred this
    month. SKIN BIOSPY of lesion done elsewhere 1.8.23 Minimal perivascular lymphocytes in
    superficial and mid dermis in subcutaneous fat there is a granulomatous inflammation with
    extensive necrosis: Granuloma made of epithelioid cells and multi nucleate giant cells.
    Stains not done and Xpert MTB not done. TB FERON 12.8.23 at APOLLO negative
    No urinary symptoms: no-abdominal symptoms, no h/o genital ulcers, no pets at home, no
    joint pains, no h/o high risk sexual activity

 VITALS
  Weight                                     77.50 Kg                  (16-Aug-2023 04:37 PM)


PHYSICAL EXAMINATION
  Hyperpigmented healed lesions at right thigh and left leg calf, non tender
  WI=77 kg

DIAGNOSIS :
   1 . Chronic EN with necrotizing granulomatous panniculitis / Tb exposure / neg IGRA ? TB


PROCEDURES PERFORMED                                                         4 empty stomach
 C.R-CINEX 600 1-0-0 FOR 6 MONTHS
  T.COMBUTOL 1000 MG 1-0-0 FOR 6 MONTHS
  T.BENADON 40 MG 1-0-0 FOR 6 MONTHS
  T.PYZINA 750 MG 2 0-0 FOR 6 MONTHS


ADVICE
 To do ALT, AST. HIV ELISA after 2 weeks and then ALT, AST every 2 weeks for first two
 months and inform if elevated or vomiting,

PLAN

 Review in 2 months
                                                                                                        18:32                   Page 1 of 2
                                                                           16-Aug-2023
                                               Pontod Date & Time :
 Printed By:700710



                                                          Keep the records carefully and bring them along during your next visit to our hospital


                 For enquires, appointments & Telemedicine consultations contact: 044 - 40401066
                                                                                                                                  -LB5110TN1979PLC006035

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'Apollo', 'clinic_pharmacy_address': 'NO 55, ELEPHANT GATE STREET Chennai Chennai Tamil Nadu India', 'clinic_pharmacy_city': 'Chennai', 'clinic_pharmacy_pincode': 'NA'}, 'doctor_details': {'doctor_name': 'Dr. RAM GOPALAKRISHNAN', 'doctor_qualifications': 'MD.MRCP (UK) ,AB (Int,Med), AB (Infectious Disease), INFECTIOUS DISEASES', 'doctor_registration_number': 'NA'}, 'patient_details': {'patient_name': 'Mr. NARENDRAN P'}, 'prescription_details': {'date_of_doctor_consultation': '16-Aug-2023'}, 'procedure': {'chief_complaints_diagnosis': 'Chronic EN with necrotizing granulomatous panniculitis / Tb exposure / neg IGRA ? TB'}, 'medicine_details': [{'medicine_name': 'C.R-CINEX 600', 'medicine_dosage': '1-0-0', 'medicine_frequency': 'empty stomach', 'course_duration': '6 MONTHS'}, {'medicine_name': 'T.COMBUTOL 1000 MG', 'medicine_dosage': '1-0-0', 'medicine_frequency': 'empty stomach', 'course_duration': '6 MONTHS'}, {'medicine_name': 'T.BENADON 40 MG', 'medicine_dosage': '1-0-0', 'medicine_frequency': 'empty stomach', 'course_duration': '6 MONTHS'}, {'medicine_name': 'T.PYZINA 750 MG', 'medicine_dosage': '2-0-0', 'medicine_frequency': 'NA', 'course_duration': '6 MONTHS'}], 'lab_test_details': {'lab_test_names': 'ALT, AST. HIV ELISA', 'procedure_request': 'after 2 weeks and then ALT, AST every 2 weeks for first two months'}}