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All Journal The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Adeputri Tanesha Idhayu
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Health Professions Medicine & Pharmacology

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Dysphagia as an Early Presenting Symptom in Dermatomyositis Idhayu, Adeputri Tanesha; Simadibrata, Marcellus; Amarendra, Gerie
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/121201158-63

Abstract

Dermatomyositis is a systemic disorder that frequently affects the esophagus, lungs, and the heart. Dermatomyositis diagnostic criteria involve evaluation of proximal muscle weakness, elevation serum levels of muscle enzyme, characteristic features of electromyography, typical muscle biopsy and classical skin rash of dermatomyositis. The prevalence of dysphagia in patients with dermatomyositis varied from 10-73%. A 40-year-old male was admitted to Cipto Mangunkusumo hospital with chief complaint of difficult in swallowing. He had been well until he began to have muscle weakness, myalgia, fatigue, and obstructive symptom in his upper digestion tract. Physical examination showed general weakness and symmetrical rash on the face, chest and back. Laboratory examination revealed anemia, thrombocytopenia, and elevated transaminase serum level. Antinuclear antibody was positive. Esophagogastroduodenoscopy showed severe esophagitis. The gastric mucosa biopsy revealed non-active chronic gastritis, antral lymph atrophy, and non-dysplastic. Biopsy of esophageal mucosa showed Barret’s esophagus with squamous epithelial cell and hard dysplasia focus. The electromyography result was suspected to a dermatomyositis. The deltoid muscle biopsy demonstrated dystrophy. Dysphagia may be an initial presenting symptom and especially prevalent in patients with dermatomyositis or other inflammatory myopathy. Dysphagia associated with these myopathies primarily affects the skeletal muscle–activated oropharyngeal phase of swallowing. It may precede weakness of the extremities or present as the sole symptom. Recommended treatments used to treat inflammatory myopathy associated dysphagia are combination of medical, rehabilitation, and interventional. Dysphagia associated with nutritional deficits, aspiration pneumonia, decreased quality of life, and poor prognosis. Patients with inflammatory myopathy and dysphagia are reported to have a 1-year mortality rate of 31%. Keywords: dysphagia, dermatomyositis, inflammatory myopathy
The Difference of C-Reactive Protein Levels in Acute Fever causedby Dengue and Typhoid Infections Idhayu, Adeputri Tanesha; Chen, Lie Khie; Suhendro, Suhendro
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 3
Publisher : UI Scholars Hub

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Abstract

Introduction. Dengue infection and typhoid fever are endemic disease in Indonesia. But in the early days of onset sometimes it is difficult to distinguish them. A simple modality test is needed to support the diagnosis. C-Reactive Protein (CRP) is an affordable, fast and relatively less expensive diagnostic tool to diagnose the causes of acute fever. This study was aimed to determine the differences of CRP level in the acute febrile caused by dengue infection or typhoid fever. Methods. A cross sectional study has been conducted among acute febrile patients with diagnosis of dengue fever/ dengue hemorrhagic fever or typhoid fever who admitted to the emergency room or hospitalized in Cipto Mangunkusumo Hospital, Pluit Hospital, and Metropolitan Medical Center Hospital Jakarta between January 2010 and December 2013. Data obtained from medical records. CRP used in this study was examined at 2-5 days after onset of fever. The other collected data were demographic data, clinical data, use of antibiotics, leukocytes, platelets, neutrophils, ESR, and length of stay in hospital. Results. 188 subjects met the inclusion criteria; 102 patients with dengue and 86 patients with typhoid fever. Median CRP levels in dengue infection was 11.65 (16) mg/L and in typhoid fever was 53 (75) mg/L. There were significant differences in median CRP levels between dengue infection and typhoid fever (p < 0.001). At the 99% percentile cut-off point, CRP levels for dengue infection was 45.91 mg/L and CRP levels for typhoid fever at 1% percentile was 8 mg / L. Conclusions. There was significantly different levels of CRP in acute fever due to dengue infection and typhoid fever. At the 99% percentile cut-off point, CRP level >45.91 mg/L was diagnostic for typhoid fever, CRP level /L was diagnostic for dengue infection. CRP level between 8 to 45.91 mg/L was a gray area for determinating diagnosis of dengue infection and typhoid fever.
Co-Authors Gerie Amarendra Lie Khie Chen Marcellus Simadibrata Murdani Abdullah Suhendro Suhendro