i will provide details of one patient which was diagnosed as GPA ONE BY ONE register the details as we need to make a clinical case presentation in RHEUMIGNITE in which presenter would be DR AYUSHI AGRAWAL (2ND YR GENERAL MEDICINE RESIDENT)
I have received and registered all the patient details from the provided documents. Here is a comprehensive structured summary of the case for the RHEUMIGNITE clinical presentation:
RHEUMIGNITE — Clinical Case Presentation
Presenter: Dr. Ayushi Agrawal (2nd Year General Medicine Resident)
Institution: Sardar Vallabhbhai Patel Institute of Medical Sciences and Research (SVP Hospital), Ellisbridge, Ahmedabad
PATIENT DEMOGRAPHICS
| Parameter | Details |
|---|---|
| Name | Mr. Ashifbhai Ganibhai Kureshi |
| MRN | 26000422128 |
| IP No. | IP2603007540 |
| Age / Sex | 29 years / Male |
| Occupation | Auto Driver |
| Addiction | Tobacco chewer (3–4 masalas/day; stopped ~1 month prior) |
| Diet | Mixed |
| Marital Status | Married, 1 child |
| Education | 10th standard |
| Admission Date | 21-03-2026 |
| Discharge Date | 03-04-2026 |
| Informant | Ganibhai (Patient's Father) |
CHIEF COMPLAINTS
- Dry cough without expectoration — 20 days
- Blood-tinged sputum — 15 days
- Weight loss ~2–3 kg in last 10 days
- Left-side nasal blockage — 20 days
- Left knee pain — 2 days before SVP admission
- Bilateral eye redness (conjunctivitis) — 3 days
HISTORY OF PRESENT ILLNESS
- Patient was initially admitted at a private hospital (12–14 March 2026) with diagnosis of LRTI; treated with Inj. Cefepime + Tazobactam, then discharged.
- Symptoms worsened; he was taken to Zydus Hospital where consolidation + ?septic arthritis was diagnosed. HRCT and USG left knee done. Took DAMA and presented to SVP.
- At SVP, first admitted under General Medicine / Emergency, then transferred to Pulmonology, and subsequently to Rheumatology.
PAST MEDICAL / SURGICAL HISTORY
- Nil comorbidity — no HTN, DM, TB, COVID, thyroid disorder, epilepsy, head trauma, or surgery
- Prior psychiatric illness: None
- Known case of Septic Arthritis (mentioned in ENT consultation notes)
FAMILY HISTORY
- Not significant
PERSONAL / SOCIAL HISTORY
- Occupation: Auto driver
- Addiction: Tobacco chewer
- Diet: Mixed | Appetite: Adequate | Sleep: Adequate (prior to this illness)
- No history of allergy, RTA, ENT surgery, or TB/COVID
EXAMINATION ON ARRIVAL (Emergency — 21/03/2026)
| Vital | Value |
|---|---|
| Temperature | Normal |
| Pulse Rate | 94/min |
| Blood Pressure | 120/70 mmHg |
| Respiratory Rate | 20/min |
| SpO₂ | 98% on Room Air |
| RBS | 141 mg/dL |
| RS | B/L air entry present, crepts + |
| CVS | S1 S2 + |
| CNS | COFVC |
| Per Abdomen | Soft |
| Pedal Edema | No |
| Clubbing | No |
CLINICAL COURSE & DIAGNOSIS EVOLUTION
| Date | Diagnosis / Key Event |
|---|---|
| 21/03/26 | Admitted under Emergency/Pulmonology — LRTI; transferred to ICU |
| 22/03/26 | S/B ENT, Ortho, Cardiology; C-ANCA sent |
| 23/03/26 | S/B Psychiatry (anxiety due to GMC) |
| 24/03/26 | Vasculitis profile sent; S/B Gastromedicine (transaminitis) |
| 26/03/26 | CECT Thorax done — nodular infiltrates + partial thrombosis of left posterobasal segmental artery; C-ANCA collected |
| 27/03/26 | Rheumatology referral — KDN for C-ANCA positivity and pulse steroid therapy |
| 28/03/26 | CT PNS done; ENT, Nephrology, Urology consulted for ?GPA |
| 30/03/26 | Rheumatology impression: GPA likely — PR-3 by ELISA ordered; Inj MPS 750 mg IV OD x3–5 days started; Inj Endoxan 900 mg planned |
| 31/03/26 | Inj Endoxan (Cyclophosphamide) 900 mg IV given |
| 02–03/04/26 | Tab Omnacortil (Prednisolone) 40 mg started; condition improved |
| 03/04/26 | Discharged — Status: Recovered; Care: Rheumatology |
Final Diagnosis: GPA (Granulomatosis with Polyangiitis) + Partial Thrombosis of Left Posterobasal Segment
KEY INVESTIGATIONS
SEROLOGY / AUTOIMMUNE
| Test | Result |
|---|---|
| C-ANCA | Positive (21/03/2026) |
| PR-3 by ELISA | Ordered (result awaited at discharge) |
| P-ANCA | Sent |
| ANA by IF | Sent |
| Coombs Direct/Indirect | Ordered (30/03/26) |
| Anti-phospholipid | Ordered |
HAEMATOLOGY (CBC trend — selected values)
| Date | Hb | WBC | Platelets | Neutrophils | ESR |
|---|---|---|---|---|---|
| 21/03/26 | 9.9 (L) | 12.24 (H) | 684 (H) | 82% (H) | 85 (H) |
| 22/03/26 | 10.3 (L) | 17.46 (H) | 795 (H) | 87% (H) | — |
| 23/03/26 | 9.6 (L) | 14.08 (H) | 858 (H) | 86% (H) | — |
| 24/03/26 | 9.5 (L) | 15.45 (H) | 675 (H) | 84% (H) | — |
| 29/03/26 | 8.8 (L) | 14.71 (H) | 640 (H) | 87% (H) | 85 (H) |
| 15/04/26 (OPD) | 11.3 (L) | 12.15 (H) | 776 (H) | 79% | 38 (H) |
- Pattern: Normocytic normochromic anaemia, neutrophilic leukocytosis, reactive thrombocytosis, elevated ESR
RENAL FUNCTION (selected)
| Parameter | Value |
|---|---|
| Creatinine | 0.58–0.76 (Low-normal; preservation of renal function) |
| Blood Urea | Normal range |
| Electrolytes | Mostly within range; one instance K+ 5.64 (H) |
| TIBC | 213 (L) — suggesting chronic disease |
URINE R/M (multiple occasions)
- Blood: PRESENT (++) on multiple occasions
- Red Cells: 4–8 / 6–8 / 10–12 per HPF (haematuria)
- Protein: Trace
- Urine ACR (31/03): 40.7 mg/g Cr (elevated) — microalbuminuria/subnephrotic
LIVER FUNCTION (early admission — 21/03/26)
| Parameter | Value |
|---|---|
| SGOT | 83 (H) → trended down |
| SGPT | 103–140 (H) → 88 → 102 |
| ALP | 214 (H) → 233 |
| Total Bilirubin | 1.2–2.3 (H) |
| Albumin | 3.5 → 3.2 (low) |
- Transaminitis — attributed to sepsis/drug-induced (HEV positive incidentally)
INFLAMMATORY MARKERS
| Test | Value |
|---|---|
| CRP | Elevated (sent multiple times) |
| ESR | 85 mm/1hr (peak) |
| Procalcitonin | 0.25–0.47 (H) — suggesting bacterial co-infection |
| Ferritin | >1650 (markedly elevated) |
| LDH | 254 (H) on 30/03 |
| NT-proBNP | 372 (H) — mildly elevated |
ABG (21/03/26 — earliest available)
- pH: 7.44 | pO₂: 38 (L) | pCO₂: 29.6 (L) | HCO₃: 19.6 (L)
- SpO₂: 74.6% (L) | Hb: 8.1 g/dL
- Interpretation: Type 1 respiratory failure, compensated respiratory alkalosis
COAGULATION
- PT/INR: 19.7 / 1.30 (H) on 21/03/26 → normalized later
- APTT: 29.5 (within range)
MICROBIOLOGY
| Test | Result |
|---|---|
| Sputum C/S (22/03/26) | Gram +ve cocci seen |
| Sputum cytology (24/03/26) | NAD |
| Sputum CBNAAT | Sent |
| Blood C/S | Sent |
| Urine C/S | Sent |
| Dengue NS1 | Ordered |
| HEV Ab | Positive (incidental) |
| HAV | Sent |
| Malaria | Negative |
RADIOLOGY FINDINGS
Chest X-Ray (multiple, 22/03 – 02/04/26)
- Patchy air space opacities in bilateral mid and lower zones — possibility of consolidation
- Persistent across multiple studies
CECT Thorax (26/03/2026)
- Dense consolidation with necrotic areas + air bronchogram: Right upper lobe, lateral segment of right middle lobe, superior segment of bilateral lower lobes
- Multiple discrete and confluent nodular infiltrates bilaterally
- Contrast filling defect in subsegmental branches of left posterior basal segmental artery — partial thrombosis
- Minimal bilateral pleural effusion with basal atelectasis
- Multiple sub-centimeter mediastinal lymph nodes
CT PNS (28/03/2026)
- Essentially normal PNS — no sinusitis, no mucosal thickening
- DNS with bony spur, convexity towards left
- Note: Right middle ear — soft tissue in mesotympanum/hypotympanum with erosion of malleus head — ?cholesteatoma with mastoiditis
2D Echo (27/03/2026)
- LVEF 60%, no RWMA, no clots/vegetations/effusion
- Mild MR, mild TR, trivial AR; RVSP 22 mmHg (no PAH)
- TAPSE 21 mm — normal RV function
USG Abdomen (24/03/2026)
- Normal liver, kidneys (bilateral ~93–95 mm), spleen
- Minimal interbowel free fluid
- Mild right pleural effusion with consolidated right lower lobe
USG Small Parts (22/03/2026)
- Left knee: Minimal knee joint effusion
- Lymph node screen: Few subcentimeter hypoechoic nodes in bilateral jugular chain — no significant lymphadenopathy
X-Ray Joints (21/03/26)
- Left knee, Right ankle: No bony lesions, normal joint spaces
ENT FINDINGS (28/03/2026 Nasal Endoscopy)
- Gross DNS to left side
- Abrasion over left Little's area with blood clots
- Right TM: ASOM; Left TM: Injected/Congested
- Right nasal endoscopy: Crusting over right septum and right middle meatus
- Left scope could not be negotiated
- No frank sinusitis; no septal perforation
- H/o nose picking
SPECIALTY CONSULTATIONS SUMMARY
| Specialty | Key Findings / Advice |
|---|---|
| Rheumatology | GPA likely; PR-3 ELISA; Pulse steroids + Cyclophosphamide |
| ENT | DNS, crusting, blood clots; CT PNS advised |
| Nephrology | Renal biopsy discussed (deferred — creatinine preserved) |
| Urology | Renal biopsy opinion — agreed with nephro |
| Cardiology | Echo: normal LV function, no PAH |
| Orthopaedics | Left knee, right ankle: normal X-rays, minimal effusion |
| Gastromedicine | Transaminitis — HEV positive incidentally; monitor LFT |
| Psychiatry | Mixed anxiety-depression secondary to GMC; Tab Sertralline 25 mg HS, Tab Meloset 3 mg HS |
| Physiotherapy | Chest PT throughout admission — diaphragmatic breathing, pursed lip breathing, chest expansion, vibration, ambulation |
TREATMENT GIVEN
Induction Immunosuppression (for GPA)
| Drug | Dose | Route | Frequency |
|---|---|---|---|
| Inj Methylprednisolone (MPS) | 750 mg | IV | OD × 3–5 days (started 30/03/26) |
| Inj Endoxan (Cyclophosphamide) | 900 mg/500 mL NS | IV slowly | Single pulse given 31/03/26 |
| Tab Omnacortil (Prednisolone) | 40 mg | PO | 1-0-0 (started 02/04/26) |
Supportive / Ancillary
| Drug | Dose | Purpose |
|---|---|---|
| Inj Pantoprazole 40 mg | BD IV | GI protection |
| Tab Shelcal 500 mg | OD PO | Calcium supplementation |
| Cap Uprise D3 60,000 IU | Once weekly (Tuesday) | Vit D supplementation |
| Eye drops CMC-LA | TDS | Dry eye / lubrication |
| Eye drops Moxifloxacin | TDS | Conjunctivitis |
| Ear drops Ciproflox | TDS | Ear |
| Syp Cremaffin 10 mL | TDS PO | Bowel care |
| Glucose powder 2 tsp | TDS | Energy supplementation |
| Xylometazoline nasal drops | TDS | Nasal congestion |
| RBS monitoring | 6-hourly | Steroid-induced hyperglycaemia watch |
| Strict I/O charting | — | Fluid monitoring |
Antibiotics (prior to GPA diagnosis, in ICU/ward)
- Inj Meropenem, Inj Linezolid (600 mg), Inj Clindamycin, Tab Doxycycline, Tab Fluconazole/Itraconazole, Inj Colistin, Inj Tranexamic acid, Inj Batroxobin (for haemoptysis)
Anticoagulation
- Tab Apixaban 2.5 mg (for left posterobasal segmental artery partial thrombosis)
DISCHARGE STATUS
- Patient Status: Recovered
- Discharge Date: 03-04-2026
- Care Provider at Discharge: Unit Rheumatology
- Follow-up: OPD — Psychiatry (after 10 days), Rheumatology (for ongoing immunosuppression monitoring)
DIAGNOSIS SUMMARY
Primary Diagnosis: Granulomatosis with Polyangiitis (GPA) — confirmed by C-ANCA positivity, multi-system involvement (upper respiratory, lower respiratory, renal, ocular, joint)
Secondary Diagnosis: Partial Thrombosis of Left Posterobasal Segmental Artery
Incidental: HEV positivity (transaminitis, monitored and resolving); Mixed anxiety-depression secondary to GMC
All patient details have been registered. Please provide any additional data (e.g., PR-3 ELISA result, bronchoscopy findings, outside HRCT images, biopsy results, or ANCA titre values) whenever ready and they will be incorporated into the case record.
Here it is
Asking for Preferences
Reading File
Reading File
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Perfect. PR3 result is now clearly documented as:
- PR3 (C-ANCA), FEIA: 72 IU/mL
- Lab reference: >3 = Positive
- Interpretation: Strongly positive PR3-ANCA, strongly supporting GPA diagnosis in this clinical context.
The two CT chest images are also received and suitable to include in the case slides.
I am ready to generate the final .pptx (clinical sequential format, with both CT images embedded).
Since you said “Here it is,” next I will proceed directly to produce the downloadable PowerPoint file.
Since you said “Here it is,” next I will proceed directly to produce the downloadable PowerPoint file.
where is the ppt?
Running Command
You’re right, it wasn’t generated yet.
Please re-upload the two CT images in this message thread (or share their file paths/URLs), and I will generate the PPT immediately and return a direct download link.
do one thing generate the ppt with whatever information you have and keep it unders 10 slides
Running Command
Writing File
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Done. I generated an 8-slide PPT (under 10 slides) using all available case data.
Download it here:
RHEUMIGNITE GPA Case Dr Ayushi Agrawal
Presentation · PPTX
If you want, I can now make a v2 with:
- CT images embedded (once re-uploaded),
- your preferred institute branding/template,
- a tighter 6-slide competition version.
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