24526194 Visualization

A 35 Age - year Age - old Age woman Sex presented Clinical_event to the medical Nonbiological_location emergency Nonbiological_location department Nonbiological_location with low Severity - grade Severity fever Sign_symptom for 3 Duration   weeks Duration , vomiting Sign_symptom for 1 Duration   week Duration and anuria Sign_symptom for 3 Duration   days Duration .
She also reported dysuria Sign_symptom and breathlessness Sign_symptom for 1 Duration   week Duration .
There was no History history History of History decreased History urine History output, History dialysis, History effort History intolerance, History chest Biological_structure pain History or History palpitation, History dyspnoea History and History weight History loss History .
Menstrual Diagnostic_procedure history Diagnostic_procedure was within Lab_value normal Lab_value limit Lab_value but she reported gradually Lab_value progressive Lab_value loss Sign_symptom of Sign_symptom appetite Sign_symptom .
Family history included smoky Detailed_description urine Detailed_description in Family_history her Family_history younger Family_history brother Family_history in Family_history his Family_history childhood, Family_history who Family_history died Detailed_description in Detailed_description an Detailed_description accident Detailed_description .
On general Diagnostic_procedure survey Diagnostic_procedure , the patient was conscious Sign_symptom and alert Sign_symptom .
She was dyspnoeic Sign_symptom and febrile Sign_symptom .
Severe Severity pallor Sign_symptom was present with mild Severity pedal Biological_structure oedema Sign_symptom .
Blood Diagnostic_procedure pressure Diagnostic_procedure was 180/100 Lab_value   mm Lab_value   Hg Lab_value and pulse Diagnostic_procedure rate Diagnostic_procedure of 116/min Lab_value regular Lab_value .
No evidence of jaundice Sign_symptom , clubbing Detailed_description cyanosis Sign_symptom or lymphadenopathy Disease_disorder was found.
Physical Diagnostic_procedure examination Diagnostic_procedure revealed bibasilar Biological_structure end Detailed_description - inspiratory Detailed_description crepitations Sign_symptom in lungs Biological_structure and suprapubic Biological_structure tenderness Sign_symptom .
There was no hepatosplenomegaly Sign_symptom or ascites Sign_symptom .
Cardiac Diagnostic_procedure examination Diagnostic_procedure was normal Lab_value .
She was found to have severe Severity bilateral Detailed_description hearing Sign_symptom loss Sign_symptom , which was gradually Lab_value progressive Lab_value for 5 Duration   years Duration .
The fundi Biological_structure were bilaterally Detailed_description pale Sign_symptom .
The patient was referred Clinical_event to the department Nonbiological_location of Nonbiological_location ophthalmology Nonbiological_location for a comprehensive eye Diagnostic_procedure examination Diagnostic_procedure .
Her visual Diagnostic_procedure acuity Diagnostic_procedure was documented as 6/18 Lab_value in both Biological_structure eyes Biological_structure with no obvious lenticular Sign_symptom opacity Sign_symptom .
Slit Diagnostic_procedure - lamp Diagnostic_procedure examination Diagnostic_procedure showed bilateral Detailed_description anterior Sign_symptom lentiglobus Sign_symptom (figure 1) with posterior Sign_symptom lenticonus Sign_symptom (figure 2).
Distant Detailed_description direct Detailed_description ophthalmoscopy Diagnostic_procedure revealed oil Sign_symptom droplet Sign_symptom sign Sign_symptom (a suggestive confirmation of the presence of lenticonus Sign_symptom ); and peripheral Biological_structure retina Biological_structure revealed multiple Detailed_description yellowish Color white Color lesion Sign_symptom - like Sign_symptom flecks Sign_symptom in the mid Biological_structure - periphery Biological_structure , and few Detailed_description blot Sign_symptom haemorrhages Sign_symptom indicative of hypertensive Sign_symptom changes Sign_symptom (figures 3 and ​4).