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Nana N. Jayadi, Nana N.
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SUBCORNEAL PUSTULAR DERMATOSIS IN A 47-YEAR-OLD WOMAN Ernaningtyas, Niken; Jayadi, Nana N.; Pandaleke, Herry E. J.
Jurnal Biomedik : JBM Vol 7, No 3 (2015): JURNAL BIOMEDIK : JBM Suplemen
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.7.3.2015.10442

Abstract

Abstrak: Subcorneal pustular dermatosis (SPD) adalah penyakit inflamasi kulit yang jarang dan kronik-rekuren. Penyakit ini umumnya didapatkan pada wanita usia diatas 40 tahun dengan etiologi belum diketahui. Gambaran klinis yang khas berupa pustul atau vesikel yang dengan cepat berubah menjadi pustul di atas dasar kulit eritematosa, menyebar periferal, central healing, dan menyembuh meninggalkan area eritematosa berbentuk polisiklik disertai munculnya lesi baru. Lesi mengenai area intertriginosa, batang tubuh, dan daerah fleksural ekstremitas. Kami melaporkan kasus seorang perempuan usia 47 tahun dengan keluhan lepuh di hampir seluruh tubuh sejak setahun lalu. Lepuh mudah pecah dan meninggalkan erosi. Status dermatologis menunjukkan generalisata makula eritematosa et hiperpigmentasi, multipel, diskret, ukuran lentikular-plakat; vesikel multipel dan pustul di atasnya; dan pustul yang pecah dengan erosi dan krusta. Pada pasien dilakukan anamnesis, pemeriksaan laboratorium, serta biopsi kulit. Pemeriksaan Gram lepuh menunjukkan hanya terdapat leukosit PMN. Laboratorium darah lengkap normal, hitung eosinofil 1,9%, hitung limfosit 24,3%, LED 70 mm/jam, dan IgE total 831.000 IU/mL. Pemeriksaan histopatologik menunjukkan spongiosis, lepuh subkorneal berisi fibrin, neutrofil, sedikit eosinofil di epidermis. Pada dermis tampak superficial perivascular inflammatory infiltration (neutrofil, limfosit, sedikit eosinofil). Pada kasus ini, diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan histopatologik yang khas untuk SPD.Kata kunci: subcorneal pustular dermatosis, pemeriksaan histopatologikAbstract: Subcorneal pustular dermatosis (SPD) is a pustular eruption which is rare, chronic, and recurrent. This condition is commonly found in women over the age of 40 years with unknown etiology. It is characterized with symmetrical pustules/vesicles that quickly develop to pustules on erythematous skin with peripherally spreading. The pustules undergo central healing leaving polycyclic erythematous areas in which new pustules arise. The lesions typically involve the intertriginous areas, trunks, and flexor of limbs. We reported a case of a 47-year-old woman with blisters and pustules all of the body surface since a year ago. The blisters ruptured easily and became erosions. The dermatological status indicated generalized erythematous hyperpigmented macules which were multiple, discrete, lenticular-plaques in size, multiple vesicles with pustules on them, and ruptured pustules leaving erosions as well as crusted areas. Anamnesis, physical examination, laboratory examinations, and a skin biopsy were performed. The Gram staining of the blister showed only PMN leukocytes. There were a normal complete blood count, eosinophil count 1.9%, lymphocyte count 24.3%, elevated ESR 70 mm/hour, and the total IgE 831.000 IU/mL. The histopathological examination indicated spongiosis, subcorneal blister consisting of fibrin, neutrophils, and few eosinophils in the epidermis. The dermis revealed superficial perivascular inflammatory infiltration (neutrophils, lymphocytes, some eosinophils). These findings were typical for SPD. Conclusion: This case was diagnosed as subcorneal pustular dermatosis based on anamnesis, physical examination, and a histopathological examination.Keywords: subcorneal pustular dermatosis, histopathological examination
LUPUS VULGARIS DENGAN LESI DISEMINATA Jayadi, Nana N.; Ernaningtyas, Niken; Niode, Nurdjannah J.; Wongkar, Marthen C. P.
JURNAL BIOMEDIK : JBM Vol 7, No 3 (2015): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.7.3.2015.9490

Abstract

Abstract: Lupus vulgaris (LV) is a chronic progressive form of paucibacillary cutaneous tuberculosis. Lesion is usually solitary in the form of nodes or erythematous plaques with an apple-jelly sign on diascopy. Disseminated LV is a rare form of cutanoeus tuberculosis with multiple lesions in several body areas. We reported a male of 40 years old with a suppurative wound on the left neck and reddish nodules on the face, neck, trunk, and limbs along with fever, night sweats, weight loss, and history of previous TB infections. There were multiple erythematous nodules and painful suppurating ulcers with enlargement of several lymph nodes. Apple-jelly sign appeared on diascopy. The FNAB showed specific granulamatous inflammation for TB with lymphocytes, epitheloid macrophages, and multinucleated giant cells. The histopathological finding showed tubercles surrounded by macrophages and lymphocytes. Anti-tuberculosis drugs category I were given for 6 months, ofloxacin, and open wound care compressed with NaCl 0.9%. In the third month of observation, there was significant improvement. Conclusion: This case was diagnosed as lupus vulgaris based on the history of lymphadenitis TB and scrofuloderma, lesions in several body area with positive diascopy test, the FNAB as well as the histopathologic result supporting the diagnosis of tuberculosis, and there was significant improvement after treatment with antiTB drugs.Keywords: lupus vulgaris, diseminata, tuberculosis, ofloksasinAbstrak: Lupus vulgaris (LV) merupakan tuberkulosis (TB) kutis pausibasiler kronis dan progresif. Lesi biasanya soliter, berupa nodus atau plak eritematosa dengan gambaran apple-jelly pada diaskopi. Lupus vulgaris diseminata merupakan bentuk TB kutis yang jarang ditemukan dengan lesi multipel pada beberapa area tubuh secara bersamaan. Kami melaporkan seorang laki-laki, 40 tahun, dengan luka bernanah pada leher kiri dan benjolan-benjolan kemerahan pada wajah, leher, badan, dan tungkai disertai demam, keringat malam, penurunan berat badan dan riwayat infeksi tuberkulosis sebelumnya. Pada pemeriksaan fisik tampak nodus eritematosa multipel disertai ulkus bernanah dan pembesaran beberapa kelenjar getah bening. Gambaran apple-jelly tampak pada diaskopi. Pemeriksaan FNAB menunjukkan gambaran radang granulomatik spesifik TB dengan adanya sel-sel radang limfosit, kelompok makrofag epiteloid, dan sel-sel datia Langhans. Pemeriksaan histopatologis memberikan gambaran tuberkel yang dikelilingi oleh makrofag dan limfosit. Terapi diberikan berupa OAT kategori I selama 6 bulan, ofloksasin, dan kompres terbuka dengan NaCL 0,9%. Pada bulan ketiga tampak perbaikan signifikan. Simpulan: Pada kasus ini, diagnosis lupus vulgaris ditegakkan berdasarkan adanya riwayat limfadenitis TB dan skrofuloderma, lesi di beberapa area tubuh sekaligus dengan pemeriksaan diaskopi positif, gambaran FNAB dan histopatologis menunjang diagnosis TB, dan pengobatan dengan OAT memberikan perbaikan bermakna.Kata kunci: lupus vulgaris, diseminata, OAT, ofloksasin