ESC 'Institute of Biology and Medicine'

Taras Shevchenko National University of Kyiv

Department of Pediatrics

The head of the department: prof. Khoperia V.G.

Lecturer: PhD Budnik T.V.

CASE HISTORY

PATIENT: Elizabeth Mitchell

Patient’s age: 4

Diagnosis: Eczema (Atopic dermatitis)

Student’s name: Faraz Vesali

Group:5

Curation date:05.01.2021
 PASSPORT DATA

Patient’s name:Elizabeth Mitchell

Patient’s age 4 years old

Hospitalization date:26.12.2020

Hospitalization diagnosis: Eczema (Atopic dermatitis)

COMPLAINS

Main complains:

Dryness

Itching

Rashes

redness, scales, and bumps that can leak fluid and then crust over

Particularization of main complains:

tend to get patches of dry, itchy skin. The itch is so uncomfortable it interferes with sleep,
making she feel miserable. Plus, scratching cause the rashes to get infected.

Additive complains:

fluid-filled blisters

over time, the skin thicken and feel scaly and leathery

ANAMNESIS MORBI (anamnesis of the disease):

The rash started at 1 year of age and worsened as time went on.

The rash was extremely itchy and the child was constantly scratching the affected areas.

The child’s quality of life was affected as the child often wakes up at night to scratch the affected

areas.

The child was seen in Dermatology since January this year, he had received 4 courses of oral

prednisone for a week and had been started on cyclosporine a month before presenting to us in the

allergy clinic. The mother did report that there is a temporary response to the oral prednisone

initially but the rash soon recurred. She had not noticed an improvement after cyclosporine had been

commenced.
 There were no specific food items that the child avoided or disliked and there were no particular

foods that made the rash worse

ANAMNESIS VITAE

Physical development of a child

Body weight: 16 kg

Height / body length: 90 cm

Physical development evaluation (by any available method): The physical development of child
during first year of life corresponded to the norm of her age

Neural-and-behavioral development of a child:

Psycho-motor functions maturation disrupted sleep approximately five nights a week, which lead to
daytime sleepiness, irritability, inattention and moodiness

Psychical development on the first year of child’s life corresponded to age norms

Feeding:

feeding during the first year of life: she was breast fed from the moment of birth till 8th month of life

Feeding regimen after 1 year of life: the weaning of the child was egg, milk and peanuts mostly

Infectious diseases in chronological order: without any complication

Prophylactic immunizations and postvaccinal reactions and complications

BCG + at 2 days,

DTwP + at 2,4,6,18 months

HepB(pediatric) + 2nd day,2,6 months

HIB + at 2,4,12 months

OPV + 6,18 months and 6 years

MMR + 12 months, 6 years

No side reactions and no complications were present during vaccinations

Tuberculin tests is negative

Allergological anamnesis: allergic conditions such as asthma and allergic rhinitis (high fever and
seasonal allergies) ,food allergies

Social-and-life conditions: satisfactory, she has a older brother and he doesn't have eczema anamnesis

Family anamnesis:

Father: John Eden , 33 age , had eczema in childhood

 Mother: Julia Susan , 38 age she is smoker

STATUS PRAESENS OBJECTIVUS

General condition of a patient: Mild severity

Position of a child in the bed: lethargic and not active

Body temperature: 39

NERVOUS SYSTEM:

Consciousness: the consciousness of the patient is clear

Behavior: adequate

Sleep relentless itch and sleepless nights

Memory short term and long-term memory are preserved

Manner of walking is abnormal due to itching

Body structure normosthenic

Reflexes all physiological reflexes are vivid and symmetric. Pathological reflexes are absent

SKIN:

Color is reddend of inflamed area

Rash elements are present on elbow , knee , ankle , scalp and wrist joints

Hair follicles are damaged on scalp

Nails no pathological signs

Edemas : peripheral edema

Soft tissues turgor is moderate in both extremities

Lymph nodes is palpable

MUSCULO-SCELETAL SYSTEM:

Vertebral column: Norm with no deformity

Extremities: show no deformities

Joints: are painless during activity with no deformities

Head

Face no deformities are present

Eyes no deformities are present, no pathological changes are present

 Nose is present in respiration no deformities are present, no pathological changes are present

Neck no deformities are present, no pathological changes are present

Oral cavity no deformities are present, ulcer rash and other pathological signs are absent

RESPIRATORY SYSTEM

Inspection of the chest:

Form of the chest: Form of the chest is normostenic

Symmetry: Chest is symmetric on both sides

Intercostal spaces: fullness of intercostal spaces

Enlargement or reduction of any part of the chest: is not present

Participation of chest in respiration: Both of lung participate in breathing with no lags

Type of breathing: sometimes breathing like asthma

Palpation of the chest:

Elasticity and resistance of the chest: chest is elastic

Vocal fremitus: decrease

Percussion:

Comparetive

Stony dullness on percussion

Pulmonary apex

height: Apex of the lung deformidity

Lower borders of lungs

Line Side Location

Midclavicular Right VI rib
Left ----
Middle Right VIII rib
axillary Left VIII rib
Scapular Right X rib
Left X rib

Excursion of lower border of the lung: It equals 4cm

Auscultation:
 Main breathing: Loud, high-pitched bronchial breath sounds over the trachea also in front above the
manubrium and behind interscapular region up to 3-4 thoracic vertebrae. Medium pitched
bronchovesicular sounds over the mainstream bronchi, between the scapulae, and below the clavicles.
Soft, breezy, low-pitched vesicular breath sounds over most of the peripheral lung fields. Puerile
above the lungs is heard. Amphoric /metallic /rude and saccadic breathing sounds are absent

Bronchophony: on symmetric parts of the chest is absent.

CARDIOVASCULAR SYSTEM

Heart region

Shortness of breath (dyspnea) when exert or when you lie down.

Fatigue and weakness.

Swelling (edema) in your legs, ankles and feet

Palpation:

Apex thrust: Is visible in the 5th intercostal space according to the horizontal line and 1cm lateral to
the vertical line. The strength of apex beat is of weak force. The resistance is of weak force area 1*1
cm.

Pulse: tachycardia tachycardia , pulse :104 per minute

Arterial pressure: Systolic pressure 95 and diastolic pressure is 75

DIGESTIVE SYSTEM

Examination of the abdomen:

CONCLUSIONS A gastrointestinal disorder is common in children with eczema, especially with

diffuse distribution.

The form of abdomen is round

Symmetry: Symmetrical

Sizes: The size of abdomen reveals no abnormalities

Participation in respiration: All sights of the abdomen changed symmetrically when breathing.

Right mid clavicular :9cm

Anterior media:8cm

Left costal arch or right-angle bisector:7cm

Gall bladder signs: no abnormalities

Pancreatic signs: is painless at the points of Mayo-Robson, Kacha, Desjardin and Chauffard’s zone

URINARY SYSTEM
 Palpation of kidneys: Not palpable, painless

Pasternatsky’s sign: Pasternatsky symptom negative in both left and right kidneys

ENDOCRINE SYSTEM

Thyroid gland palpation: Not painful, soft and smooth

Sexual development: correspond to norm

Menstruations: _

ADDITIVE EXAMINATIONS PLAN

No laboratory test is needed for eczema

Instrumental

useing patch testing or other tests to rule out other skin diseases or identify conditions that accompany
eczema

ADDITIVE EXAMINATIONS RESULTS:

No lab test is needed to identify atopic dermatitis (eczema) only examing skin and revewing
medical history

DIFFERENTIAL DIAGNOSIS:

seborrheic dermatitis

Discoid (nummular) dermatitis

Irritant contact dermatitis (especially of the hands)

Allergic contact dermatitis and airborne contact dermatitis

Photo-allergic and photo-irritant dermatitis

HIV dermatitis

Drug-induced dermatitis

Cutaneous T-cell lymphoma

Psoriasis , especially the erythrodermic type

Scabies

Insect bites

filariasis

neurodermatitis
 FINAL DIAGNOSIS: Eczema or Atopic Dermatitis

TREATMENT:

Fatty fish. The child may be able to reduce her symptoms by eating fatty fish, such as salmon and
herring.

Foods containing quercetin

Foods containing probiotics. Probiotic foods, such as yogurt, contain live cultures that help support a
strong immune systemHeart failure therapy:

avoiding soap and other irritants. Certain creams or ointments also may provide relief from the itching.
(barrier cream)

Medications: antihistamine: fexofenadine and cetirizine (non-sedating)

Diphenhydramine (Benadryl)

Dosage : liquid 12.5 mg/5 milliliters = 4 ml (according to child's weight)

And hydroxyzine (atarax):for taking at night (oral)

Dosage: 50 mg per day (according to child's age) divided in small doses

Emmolients:

Dermalex eczema: to relieve itchy and dry skin , while moisturising and preventing new flare-ups

Eumovte: to break the itch and scratch cycle with with a 24 hour moisturising action.

Prevention:

By keeping your child's skin from getting dry or itchy and avoiding triggers that cause flare-ups.
*The child should take short baths or showers in warm (not hot) water. By Using mild unscented
soaps or non-soap cleansers and pat the skin dry before putting on cream or ointment.

*If a baby is at risk of eczema because of a family history, it is best to breastfeed them exclusively
for the first three months of life, or longer if possible.

signature

09.01.2021

Points/traditional mark________________ Lecturer’s signature_______________