This is a good case for #MedTwitter . 19-year old girl presenting with constipation (passes once in 7-8 days) intermittent abdominal distension since birth. Barium enema unremarkable. Defecography normal. CT normal other than loaded stools. Fever spikes, recent WIDAL positive.

Has taken repeated courses of antibiotics, transient response and then again gets fever spikes. Constipation responds to laxatives with multiple loose stools, relapses on stopping. Routine blood reports normal. But diagnosis didn’t need so many tests and was obvious clinically!

She was also taking some treatment from dermatologist for pimples on the face and dry skin on the hands. I wonder why the dermatologist didn’t think of the diagnosis which was staring them in the face. She also had dry, cracked lips. The skin on hands was dry and taut. Diagnosis?

All the clinical features clearly point to an obvious diagnosis that has been missed by biggest public hospitals in the country where this patient has been evaluated: SLE or similar autoimmune disorder. Asked for ANA and it is strongly positive 1:1000 with normal C3 and C4.

Have referred the patient to a rheumatologist for further evaluation. Apni aukaat itne tak hi hai, I’m a surgeon after all and not supposed to know such things 😁