Rt. hip pain을 주소로 내원한 62세 여자환자 Case conference Rt. hip pain을 주소로 내원한 62세 여자환자 IG R3 최인승

Patient information Chief complaint Rt. hip pain onset) 1달 전 11770168 62/F 양O의 Chief complaint Rt. hip pain onset) 1달 전 Present illness 62/F CHB(1999년 진단, 2005년 부터 본원 IG f/u)로 본원 IG, HTN, Osteoporosis(2013년 진단)로 일산백병원에서 f/u 하는 자로 내원 1달 전부터 Rt. Hip pain 있어 일산 백병원 방문하여 시행한 검사상 Fx. Subtrochanter femur Rt. 소견 보였고 trauma Hx없고 BMD -3.5(femu) 소견 보여 pathologic Fx 가능성에 대한 F/E위해 본원 IG opd방문함 1999년 세브란스에서 Chronic Hepatitis B로 진단받고 투여받은 Hx 있고

Past medical Histroy DM/HTN/Tbc/Hepatitis (-/+/-/+) Medication (+) HBs Ag(+), HBe Ag/Ab(-/+) HBV DNA PCR(-) Medication (+) Adefovir 10mg Sevikar 5/20mg Calteo-40(Ca+Vit D) OP Hx (+) Athroscopy knee Lt(2014.9) Nailing Femur Rt(2015.10) Smoking (-) / Alcohol (-) Family history (-)

Review of System Fever (-) Dizziness (-) Weakness (-) General Fever (-) Dizziness (-) Weakness (-) Weight change(-) Edema(-) Skin Rash (-) Itching (-) Pigmentation (-) Sweating(-) Petechiae(-) HE/ENT Headache (-) Rhinorrhea (-) Sore throat (-) Hoarseness (-) Respiratory Cough (-) Sputum (-) Dyspnea (-) Hemoptysis (-) Cardiac Chest pain (-) Palpitation (-) Syncope (-) GI A/N/V/D/C (-/-/-/-/-) Abdominal pain (-) Hematochezia (-) Melena (-) Hematemesis (-) Extremity Pain(+) : Rt. Hip pain, Tenderess(-) Numbness(-)

Physical examination 120/80 mmHg – 92/min – 20/min – 36.5 °C Vital sign 120/80 mmHg – 92/min – 20/min – 36.5 °C Ht : 154 cm Wt : 62 kg BMI : 27.19 Kg/m2 General Alert consciousness Acutely ill-looking appearance HE/ENT Cervical LN enlargement (-) redness(-) Neck vein engorgement (-) Thorax Symmetrical chest expansion Clear breathing sound without rale Regular heart beat without systolic murmur Abdomen Soft and flat abdomen Normoactive bowel sound Pain/Td/RTd(-/-/-) CVA Td(-/-) Extremity Motor : intact / Sensory : intact Pretibial pitting edema(-/-)

Past clinical course CHB 진단(세브란스) 본원 IG로 f/u 옮김 Adefovir start 1999 2005.8 2013 2015.9 CHB 진단(세브란스) 본원 IG로 f/u 옮김 Adefovir start Osteoporosis 진단 Femur Fx 2007.11 1999.11 임상약으로 변경 Interferon alpha Adefovir 10mg qd 2001.6 Lamivudine 2014 Ibandronate 3mg IV q 3m Calteo-40 (Ca + Vit D)

외부병원 lab finding CBC/DC Chemistry Urine Chemistry(24hrs) 4,920/mm² - 13.3 g/dl – 39.6% - 128,000/mm3 (Seg. 70.3%) Chemistry Prot/Alb 6.3/3.7 g/dL BUN/Cr 19.4/1.01 md/dL TB/DB 0.67/- mg/dL Na/K/Cl 139/4.0/112 mmol/L AST/ALT 20/32 IU/L Ca/P/Mg 8.3/1.9/- mg/dL ALP/γGT 232/15 IU/L Glucose 120 mg/dL CRP - mg/dL Ionized Ca 1.24 mmol/L Urine Chemistry(24hrs) Creatinine 583.1 mg/day Calcium 325.5 mg/day Phophrus 235.5mg/day

PTH 25-(OH) Vit BMD (2015.10.2) 27pg/mL (15~65pg/mL) 9.7 ng/mL (15~20ng/mL) BMD (2015.10.2) L-spine : -3.3 Femur : -3.5

Final diagnosis #1 Fanconi syndrome c Osteoporosis c pathologic Fx femur Rt. s/p OR/IF #2 Chronic hepatitis B c LC(child A, 5, MELD 8) #3 HTN

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