A female patient 60 year with congenital Atrial septal defect (ASD) without shunt (now 26mm dia) and multiple peripheral pulmonary artery stenosis with marfan-like features like hypermobility of joints, high myopia, flat foot presents with slowly increasing bilateral swelling of feet (see the pic) over a period of 5 weeks following a viral fever. Swelling is associated with joint pains all over the body relieved with bed rest and hot-pad and increased with cold. Her P=70/min, BP= 145/80, Resp=22/min, Temp=normal, edema-pitting in nature tender, jaundice-cyanosis-clubbing-anemia are absent.
She had been operated for chocolate cyst ( rt) when 25 years, for strangulated Inguinal hernia Lt when 56 years, Blood transfusion was carried on three occasions. The patient is suffering from spondylolisthesis with severe reduction of joint spaces, colonic diverticulosis (MRI) and bilateral OA of…
