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Prasetyadi Mawardi
Bagian Ilmu Kesehatan Kulit dan Kelamin, Fakultas Kedokteran, Universitas Sebelas Maret Surakarta/RSUD Dr. Moewardi, Surakarta
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Terapi Doxycycline Pada Laki-laki Homoseksual dengan Sifilis Sekunder dan Infeksi Human Immunodeficiency Virus Anggana Rafika Paramitasari; Imroatul Ulya; Agung Triana Hartati; Susanti Rosmala Dewi; Prasetyadi Mawardi
MEDICINUS Vol 34 No 1 (2021): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (117.196 KB) | DOI: 10.56951/medicinus.v34i1.52

Abstract

Background: Re-emergence of syphilis is increasing especially among MSM (men who have sex with men) patients. Syphilis in HIV-infected patients is reported to show faster and higher risk for progression to neurosyphilis. Co-infection of syphilis and human immunodeficiency virus (HIV) is correlated with decrease in CD4 and increase in HIV-RNA. Doxycycline has an antiinflammatory effect associated with decrease of HIV-RNA and increase of CD4 in HIV patients. Case: A 20 years old foreigner MSM man complained about non-itchy red spots throughout his body for 2 days with slight fever. He has a history of more than 10 sexual partners and rarely use condom. Physical examination revealed various sizes of erythematous macules and papules on his trunk and extremities. We found erythematous plaques with regular border but no ulcer on his scrotum and no secrete from his urethra. There was enlargement in the inguinal lymph node. VDRL and TPHA examinations were 1:32 and 1:640, respectively. HIV test was reactive with CD4 value 558 cells/ml. Treatment consists of doxycycline 2x100 mg for 14 days and also ARV (nevirapine, lamivudine and zidovudine). His symptoms were improved after a month accompanied with decreased VDRL to 1:2 and slightly increased CD4 to 570 cells/ml. Discussion: Doxycycline is a second line treatment for syphilis that is known to help decreasing the viral load and increasing CD4 level in syphilis with HIV. A significant decrease in VDRL titer in this patient indicates a successful therapy.
Tinjauan Histopatologi pada Pyoderma Gangrenosum dengan Infeksi Sekunder Wibisono Nugraha; Danu Yuliarto; Eka Devinta Novi Diana; Alfina Rahma; Prasetyadi Mawardi; Frieda; Ambar Mudigdo
MEDICINUS Vol. 36 No. 2 (2023): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/medicinus.v36i2.123

Abstract

Background: Pyoderma gangrenosum (PG) is a complex neutrophilic dermatosis, characterized by sterile, painful, necrotic ulcer, and is associated with systemic conditions. PG manifests as papules and vesicles that evolve into painful ulcers. Incidence of PG is relatively rare in Dr. Moewardi Hospital, so it is important to identify and correctly diagnose PG based on its’ histopathological features. Case A 54-year-old man complained of painful scab on several body parts. Hematoxylin and eosin staining in the epidermal layer showed a basket-weave orthokeratosis with necrotic tissue, acanthosis, and basal cell hypermelanosis. In the dermis layer there is a lymphocyte and neutrophil cell infiltrate with slight appearance of leukocytoclastic. Discussion: Pyoderma gangrenosum is a reactive, non-infectious inflammatory dermatosis (neutrophilic dermatoses). In this case, PG occurs in 54-year-old man as painful scab on back and legs. Classical PG characterized by papules, pustules, crusted or necrotic plaque, which typically have undermined, overhanging, dusky purple edges with surrounding induration and erythema. In this patient, the epidermal layer showed ulceration and slight appearance of leukocytoclastic vasculitis in the dermis area and lymphocyte infiltrate with slight neutrophil in the perivascular accompanied by erythrocyte extravasation, which support the diagnosis of PG.
Co-Authors Agung Triana Hartati Alfina Rahma Ambar Mudigdo Anggana Rafika Paramitasari Danu Yuliarto Eka Devinta Novi Diana Frieda Imroatul Ulya Susanti Rosmala Dewi Wibisono Nugraha