Case report:
A non-hypertensive, non-diabetic, euthyroid young female of 25 years age from rural Coochbehar presented to us at MJN Medical College and Hospital, with 1 year history of mild cough and mMRC grade 1 dyspnea, with the dyspnea worsening abruptly since last week. It was accompanied by low grade fever. Her dyspnea was not associated with wheezing, diurnal, seasonal or postural variation; cough was dry and without diurnal variation. She denied chest pain, joint pain, history of cyanosis, paroxysmal nocturnal dyspnoea, history of prior tuberculosis, or any history suggestive of allergy or atopy. She had no addiction, no exposure to any known agents that might cause hypersensitivity; her menstrual history was normal and she has one living issue of 16 months age.
During examination it was noted that she had a tall stature (height: 170 cm) but no features of joint hyperextensibility, loose, lax skin, eye or heart problems. Her vitals were all stable except for her respiratory rate being 30/ minute and pulse rate being 110/minute. Her accessory muscles of respiration were visibly working.
She had multiple brownish nodular skin lesions localized around her nasolabial folds and surrounding areas of the face (FIG 1.A).