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Ecthyma Contagiosum (Orf Virus) Masquerading as Subcorneal Pustular Dermatosis: A Diagnostic Pitfall in an Adolescent Lisa Alverina; Luh Made Mas Rusyati; Suharmono Hadi; Herman Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1485

Background: Ecthyma contagiosum (Orf) is a zoonotic viral infection caused by a Parapoxvirus, typically presenting as a self-limiting, solitary cutaneous lesion on the hands of occupationally exposed individuals. Atypical, multifocal, or pustular presentations can pose a significant diagnostic challenge, mimicking various inflammatory dermatoses. Case presentation: We present the case of a 17-year-old female with no direct animal contact who developed a progressive, widespread, and painful pustular eruption on her extremities over three weeks. The clinical presentation was highly suggestive of Subcorneal Pustular Dermatosis (SPD), prompting treatment with systemic corticosteroids, which led to clinical worsening. A delayed epidemiological history revealed an environmental link to a nearby goat farm and a family cluster of similar, milder lesions. A diagnostic punch biopsy was pivotal, revealing viral cytopathic effects, including extensive ballooning degeneration and epidermal necrosis, inconsistent with SPD. Subsequent bacterial culture confirmed superinfection with Enterobacter cloacae ssp. cloacae. The diagnosis was established by the pathognomonic histopathological findings. Conclusion: The patient’s steroid therapy was immediately ceased, and targeted antibiotic therapy was initiated, leading to complete resolution. This case highlights the Orf virus as a critical clinical chameleon and a diagnostic pitfall for generalized pustular eruptions. It underscores the necessity of a high index of suspicion for zoonoses, even in non-occupational settings, and confirms the indispensable role of histopathology in differentiating viral cytopathy from sterile neutrophilic dermatoses to prevent iatrogenic harm from inappropriate immunosuppression.

Mixed Type Basal Cell Carcinoma Treated with Excision and Defect Closure Using Advancement Flap: A Case Report Darmaputra, I Gusti Nyoman; Ketut Kwartantaya Winaya; Adelia Suryani; Herman Saputra; Putu Setiani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i2.931

Background: Basal cell carcinoma (BCC) is a localized malignant tumor in the basal layer of the epidermis thought to be the result of prolonged sun exposure and associated with gene mutations in most cases. Although rarely metastazises, BCC can cause high levels of morbidity due to its locally destructive nature. There are several modalities for managing BCC, and the defect caused by the lesion can reconstructed by local flap. Case presentation: We present a 55-year-old woman with a chief complaint of a blackish lump on the left maxillary region, growing bigger, and frequent episodes of bleeding. The lesion was excised and followed by histopathological examination, which revealed mixed subtype BCC. Closure of the defect with an advancement flap was performed with favorable results. Conclusion: Surgical excision is the best option for managing BCC, while a skin flap is preferred to close defects for lesions on the cheek.

Beyond the Usual Suspects: Phialophora verrucosa Chromoblastomycosis in a Swimming Pool Attendant and Gardener Andrew Wicaksono; Ni Luh Putu Ratih Vibriyanti Karna; Mario Korwa; Nandya Dwizella; Herman Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1422

Background: Chromoblastomycosis (CBM) is a chronic, debilitating subcutaneous mycosis caused by traumatic inoculation of dematiaceous fungi. As a Neglected Tropical Disease, it poses significant diagnostic and therapeutic challenges, particularly in the endemic tropical and subtropical regions where it is most prevalent. While Fonsecaea pedrosoi is the most common etiologic agent, infections by other species are crucial to document for accurate epidemiological surveillance. Case presentation: A 26-year-old immunocompetent male presented with a four-year history of a slowly progressive, verrucous plaque on his right hand, initiated by minor trauma. His history was notable for regular gardening without protective gear. A comprehensive diagnostic workup was performed. Dermoscopy revealed features characteristic of CBM, including reddish-black dots and yellowish-orange areas. While direct microscopy of skin scrapings was negative, histopathology of a skin biopsy confirmed a suppurative granulomatous reaction with pathognomonic muriform cells. Fungal culture on Sabouraud's dextrose agar definitively identified the causative agent as Phialophora verrucosa. The patient showed marked clinical improvement after three months of treatment with oral itraconazole (200 mg/day). Conclusion: This case highlights the successful diagnosis of a rare CBM pathogen in Indonesia through a systematic, multimodal approach. It reinforces the need for a high index of suspicion for this mycosis in patients from endemic areas with chronic verrucous lesions and a history of cutaneous trauma. The essential role of mycology culture for definitive species identification is underscored, a critical step for guiding therapy and informing public health strategies.

Necrotic lower extremities ulcers caused by calciphylaxis in chronic renal failure patient Nyoman Suryawati; Herman Saputra
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 1 No. 1 (June 2018)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/vcjd9e41

Introduction: Lower extremity ulcers often create diagnostic challenges and influence patient morbidity and mortality. The most common causes are venous insufficiency, arterial insufficiency, and neuropathic. Ulcers associated with systemic condition often face diagnostic and therapeutic challenge. We report a necrotic lower extremity ulcer caused by calciphylaxis in a patient with chronic renal failure. Case: We reported a 48-year-old Javanese woman, complained of painful lower extremities ulcers since 1.5 months ago. The patient had a history of renal failure and hypertension, undergone routine hemodialysis since 13 years ago, and used Continuous Ambulatory Peritoneal Dialysis (CAPD) since one year ago. Dermatology status on dorsum pedis sinister as well as cruris dexter and sinister showed multiple ulcers on livid skin covered by black eschar, accompanied by tenderness. Laboratory results showed anemia (Hb 7.6), hypoalbuminemia (2.7), increased serum urea level (170.4 mg/dl), increased serum creatinine (11.23 mg/dl), increased calcium (10.4 mg/dl), high inorganic phosphorus (8.5 mg/dl) and high parathyroid hormone (2,164). BOF examination showed abdominal calcification, while radiographic examination on cruris dexter et sinister showed soft tissue calcification and osteoporosis. Histopathology result supported the presence of calciphylaxis. The patient was diagnosed with stage V chronic renal failure, hypertension, and calciphylaxis caused by secondary hyperparathyroidism. She was managed by low calcium and phosphate diet, lanthanum, paracetamol, folic acid, adalat oros, captopril and wound debridement. Conclusion: Calciphylaxis is rare phenomenon of cutaneous necrosis associated with end-stage renal disease. Control of end-stage renal disease may be an important factor for treatment of calciphylaxis and patient with calciphylaxis usually had a poor prognosis.

Generalized pustular psoriasis with nail psoriasis in children: a case report Dewi Gotama; Prima Sanjiwani Saraswati Sudarsa; Herman Saputra
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 2 No. 2 (December 2019)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/gm279n15

Background: Pustular psoriasis in children is one of the clinical variants of psoriasis. It is classified into generalized pustular psoriasis (GPP) and localized pustular psoriasis. The aetiology of psoriasis in children has not been known but is believed to be multifactorial. Nail psoriasis rarely occurs in children who suffer from skin psoriasis, with an incidence lower than that reported in adults. The diagnosis is generally made from the clinical and histological examination. The choice of therapy depends on the severity of the disease. Until now, there have been no specific guidelines for the management of psoriasis in children. Case report: A-15-years-old Balinese girl presenting with erythema, confluent scaly plaques over the trunk and extremities with pustules localized on the lower extremity. She had a history of fever before the lesions appear. Right third digital nails examination showed subungual hyperkeratosis and onycholysis. Positive auspitz sign and karsvlek phenomena were found. Biopsy result suitable for psoriasis. The patient got improvement after treated with methotrexate tablet orally and desoximetasone cream topically within four weeks without any side effect. Conclusion: Combination therapy with methotrexate tablet and desoximetasone cream give an effective result. However, the safety and side effects of methotrexate in children still need further monitoring.

Lichen amyloidosis with combined topical therapy: a case report Made Sanitca Indah; Ni Made Dwi Puspawati; Herman Saputra
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 2 No. 2 (December 2019)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/24tjs491

Introduction: Lichen amyloidosis (LA) is a rare case, characterized by circumscribed, highly pruritic, hyperkeratotic, and hyperpigmented papules occurring typically over the shins, outer aspects of upper arms, and on the upper back with amyloid deposits in the papillary dermis. Several therapeutic strategies, including topical steroids, oral antihistamines, cyclosporine, retinoids, laser, phototherapy, cryosurgery, and surgical interventions, have been reported as treatment options for patients with LA, but no standardized treatment has been established. Case report: A 58-year-old man came to the Dermatovenereology Outpatient Department complaints of itchy blackish-brown papules on the shins. Dermatology examination found discrete multiple hyperpigmentation papules and plaque covered with white scale. A scar-like center surrounded by brownish circles or white edges was found from the dermoscopic examination. The histopathological examination found thickened keratin with compact orthokeratosis and hyaline materials in the papillary dermis with dendritic melanophages. The patient diagnosed with LA and treated by combining desoximetasone cream 0.25% with 3% salicylic acid. The papules on the legs had flattened in the patient, with a significant improvement in the severe itching after three weeks. Conclusion: Combination therapy of potent corticosteroids and keratolytic seems to be an appropriate modality and well-tolerated by LA patients. Skin lesion becomes thinner, and pruritus is reduced.

Mixed Type Basal Cell Carcinoma Treated with Excision and Defect Closure Using Advancement Flap: A Case Report Darmaputra, I Gusti Nyoman; Ketut Kwartantaya Winaya; Adelia Suryani; Herman Saputra; Putu Setiani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i2.931

Background: Basal cell carcinoma (BCC) is a localized malignant tumor in the basal layer of the epidermis thought to be the result of prolonged sun exposure and associated with gene mutations in most cases. Although rarely metastazises, BCC can cause high levels of morbidity due to its locally destructive nature. There are several modalities for managing BCC, and the defect caused by the lesion can reconstructed by local flap. Case presentation: We present a 55-year-old woman with a chief complaint of a blackish lump on the left maxillary region, growing bigger, and frequent episodes of bleeding. The lesion was excised and followed by histopathological examination, which revealed mixed subtype BCC. Closure of the defect with an advancement flap was performed with favorable results. Conclusion: Surgical excision is the best option for managing BCC, while a skin flap is preferred to close defects for lesions on the cheek.

Ecthyma Contagiosum (Orf Virus) Masquerading as Subcorneal Pustular Dermatosis: A Diagnostic Pitfall in an Adolescent Lisa Alverina; Luh Made Mas Rusyati; Suharmono Hadi; Herman Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1485

Background: Ecthyma contagiosum (Orf) is a zoonotic viral infection caused by a Parapoxvirus, typically presenting as a self-limiting, solitary cutaneous lesion on the hands of occupationally exposed individuals. Atypical, multifocal, or pustular presentations can pose a significant diagnostic challenge, mimicking various inflammatory dermatoses. Case presentation: We present the case of a 17-year-old female with no direct animal contact who developed a progressive, widespread, and painful pustular eruption on her extremities over three weeks. The clinical presentation was highly suggestive of Subcorneal Pustular Dermatosis (SPD), prompting treatment with systemic corticosteroids, which led to clinical worsening. A delayed epidemiological history revealed an environmental link to a nearby goat farm and a family cluster of similar, milder lesions. A diagnostic punch biopsy was pivotal, revealing viral cytopathic effects, including extensive ballooning degeneration and epidermal necrosis, inconsistent with SPD. Subsequent bacterial culture confirmed superinfection with Enterobacter cloacae ssp. cloacae. The diagnosis was established by the pathognomonic histopathological findings. Conclusion: The patient’s steroid therapy was immediately ceased, and targeted antibiotic therapy was initiated, leading to complete resolution. This case highlights the Orf virus as a critical clinical chameleon and a diagnostic pitfall for generalized pustular eruptions. It underscores the necessity of a high index of suspicion for zoonoses, even in non-occupational settings, and confirms the indispensable role of histopathology in differentiating viral cytopathy from sterile neutrophilic dermatoses to prevent iatrogenic harm from inappropriate immunosuppression.

Maculopapular drug eruption with histopathological features of psoriasiform drug eruption in a patient with psoriasis vulgaris: a case report Djuanda, Kevin Jonathan; Nyoman Suryawati; I. G. A. A. Elis Indira; Herman Saputra
Indonesian Journal of Biomedicine and Clinical Sciences Vol 57 No 4 (2025)
Publisher : Published by Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/inajbcs.v57i4.23282

Maculopapular drug eruption in patient with psoriasis are rarely reported and require close monitoring during oral corticosteroid therapy due to the potential risk of flare following dose reduction or discontinuation. A 47-yo male with a history of psoriasis vulgaris on cyclosporine therapy developed erythematous patches with scaling following the administration of amoxicillin, mefenamic acid, and antitetanus injection after a nail puncture injury. Vital signs were within normal limits. Dermatological examination revealed multiple well-demarcated erythematous macules, patches, and papules with geographic patterns measuring 0.6×0.9 cm to 2.5×4 cm, some confluent, accompanied by white scales and desquamation. Histopathological findings were consistent with psoriasiform drug eruption. The Naranjo score for amoxicillin was 4, showed a possible correlation. A diagnosis of maculopapular drug eruption suspected to be induced by amoxicillin was established. Clinical improvement observed following the administration of oral corticosteroids, cyclosporine, antihistamines, and emollients. The diagnosis of maculopapular drug eruption requires correlation of rash onset and drug initiation as well as monitoring of symptom resolution after drug discontinuation the suspected drug. Histopathological examination may support the diagnosis, with the presence of eosinophils serving as an indicator of drug-induced etiology. Management of maculopapular drug eruption in patients with psoriasis includes withdrawal of the suspected causative agent, symptomatic therapy, systemic corticosteroids, and immunosuppressive treatment as indicated.

The Oral-Skin Axis in Autoinflammation: A Case Report of Severe Refractory Generalized Pustular Psoriasis (GPP) Resolved by Comprehensive Periodontal Intervention Ni Putu Wina Widyastuti; Prima Sanjiwani Saraswati Sudarsa; Herman Saputra; Handelia Phinari; Luh Putu Venny Cempaka Sari; Kevin Jonathan Djuanda; Mario Korwa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1499

Background: Generalized pustular psoriasis (GPP) is a severe, IL-36-driven autoinflammatory dermatosis, distinct from psoriasis vulgaris. Chronic periodontitis (CP) is a dysbiotic inflammatory disease sharing pathogenic pathways (IL-1, IL-17). An "oral-skin axis" has been hypothesized, but definitive clinical evidence of CP driving a GPP flare is scarce. Case presentation: We present a 37-year-old male with a history of plaque psoriasis who developed a severe, refractory GPP flare (GPPASI 35.8) with high-grade fever (38.9°C), profound neutrophilic leukocytosis (22.5 x 10³/µL), and markedly elevated CRP (150 mg/L). The flare was resistant to maintenance methotrexate. Workup revealed severe CP with multiple periapical abscesses, culture from which grew Porphyromonas gingivalis and Fusobacterium nucleatum. The patient underwent a comprehensive dental intervention, including emergency extractions and full-mouth debridement, with concurrent peri-operative Amoxicillin-Clavulanate therapy. This combined intervention led to a rapid resolution of fever, neutrophilia, and cutaneous pustulation within 72 hours, without any escalation of systemic immunomodulators. He achieved complete remission (GPPASI 1.0) at 3-month follow-up. Conclusion: This case provides a strong temporal association supporting the oral-skin axis, highlighting severe periodontitis as a potent trigger and amplifier for GPP. The rapid resolution following a combined surgical and antibiotic intervention suggests that targeting the oral inflammatory and microbial reservoir is a critical, actionable strategy. We strongly recommend consideration of a comprehensive dental/oral screening in patients with refractory GPP.

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