Man with generalized Blisters

Mr. John 71 year old man who was earlier worked as a driver had been having generalized blisters for 5-6 month duration.As he told before appearing the Blisters,the skin became Itchy then spontaneously Blisters appeared all over the body including the scalp.And patient complained of burning type sensation also.He had not had fever.

No Hx of insect bites.

He was diabetic & hypertensive.But he idnot have any significant drug Hx or Allergic Hx.

On Examination of this patient,

Patient was ill looking ,mildly febrile, not icteric ,not pale But had bilateral pitting odema in the legs & his abdomen was midly disteneded.There was no mouth ulcers.

His Skin has generalized Hyperpigmented papular Blistering eruptions.And Hyperkeratative skin in the legs & arms.

Regarding the CVS,RS there were no abnormalites detected.

1. What are your Differential Dx for this patient???
2. What are the Ix needed you to come to a defenitive Dx???
3. How you are going to Rx this patient???

Woman with Backache

Mrs Valantine 50 year old housewife presented with backache for 1 month duration.She was previously well &  Backache has insidious onset which gradually worsened.She felt pain on the lower dorsal region.Not only that  but she complains of a band like constricting type pain going around her chest just below the costal margin.Initially the pain occured with movements.then experienced pain even at the rest.There was loss of appetite also.

No Hx of Trauma.She was not on long term drug Rx.

On examination

She had Localized Tenderness over the Dorsal Spine

She was found to have the signs of cord compression below the level of T10-11 vertebrae.

In other Systems there was no other abnormality detected.

These Investigations were done

HB - 13.5g/dl

WBC - 9800/ml

PLT - 252,000

ESR - 134mm/1 hour

AST - 12U/l

ALT - 17U/l

MRI Scan of the Thoraco - Lumbar Spine was done.

1. What are the Changes that you can appreciate in this MRI Scan???
2. What are the Symptoms & Signs of Cord Comperssion???
3. What are the possible causes for her chronic back pain???
4. How would you confirm the Dx???
5. What Are the Rx option available for this patient & how you Mx this Patient???