A 65year old male presented to GM with swelling on left back region from 10 days

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A 65M who is a construction worker from Nalgonda presented to OPD.

CHIEF COMPLAINT: Swelling associated with pain on left back region since 10 days.

HOPI: The patient fell down and  presented with a swelling on left back 10 days ago and the pain was localised to the area of swelling . The pain was gradually progressive and aggrevated on sleeping. They went to a govt. Hospital and there they did a surgery and he was still not relieved , so he came here.

PAST HISTORY: 10 years back the patient had a injury to left big toe and it was not relieved so he went to hospital and then  found out that he was diabetic and the toe was amputated. He was having similar amputations for 3 times. He had dialysis for 4 times in his past because of CKD. He was a known case of IDDM from past 6yrs and HTN from past 4yrs.

PERSONAL HISTORY: Diet: Mixed 

                                       App: N 

                                       Sleep: N

                                   Alcoholic, non-smoker.

FAMILY HISTORY: His sister is a known case of DM.

 GENERAL EXAMINATION: Mild pallor, No icterus , No cyanosis, pedal edema (pitting type), no lymphadenopathy, no clubbing.