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Diffuse Large B Cell Lymphoma, Bilateral Lower Extremity Lymphedema, and Ulcerated Inguinal Lymph Node LUGITO, NATA PRATAMA HARDJO; KURNIAWAN, ANDREE; YANTO, THEO AUDI
Indonesian Journal of Cancer Vol 8, No 1 (2014): Jan - Mar 2014
Publisher : "Dharmais" Cancer Center Hospital

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (504.521 KB)

Lymphedema (LE) is a chronic medical condition characterized by lymphatic fluid retention, resulting in tissue swelling. There are two general classifications of LE; primary and secondary which are based on two mechanisms; lymphatic obstruction and lymphatic interruption. The most common cause of LE in the developing world is secondary to an infection known as filariasis. Cancer including Hodgkin and non-Hodgkin lymphomas; and its treatment are some causes of secondary LE. LE also could maintain the persistence of an occult localization of lymphoma. This case illustration describes a female, 57 year-old with stage II lymphedema of both legs, bilateral inguinal lymphadenopathies that were biopsied. The filarial blood examination was negative. Biopsies showed diffuse large B-cell lymphoma.

Diffuse Large B Cell Lymphoma, Bilateral Lower Extremity Lymphedema, and Ulcerated Inguinal Lymph Node LUGITO, NATA PRATAMA HARDJO; KURNIAWAN, ANDREE; YANTO, THEO AUDI
Indonesian Journal of Cancer Vol 8, No 1 (2014): Jan - Mar 2014
Publisher : Indonesian Journal of Cancer

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (504.521 KB)

Lymphedema (LE) is a chronic medical condition characterized by lymphatic fluid retention, resulting in tissue swelling. There are two general classifications of LE; primary and secondary which are based on two mechanisms; lymphatic obstruction and lymphatic interruption. The most common cause of LE in the developing world is secondary to an infection known as filariasis. Cancer including Hodgkin and non-Hodgkin lymphomas; and its treatment are some causes of secondary LE. LE also could maintain the persistence of an occult localization of lymphoma. This case illustration describes a female, 57 year-old with stage II lymphedema of both legs, bilateral inguinal lymphadenopathies that were biopsied. The filarial blood examination was negative. Biopsies showed diffuse large B-cell lymphoma.

Poor Sleep Quality of Hospitalized Geriatric Patients in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia Nata Pratama Hardjo Lugito; Theo Audi Yanto; Andree Kurniawan; Indra Wijaya; Margaret Merlyn Tjiang; Resa Setiadinata; Stevent Sumantri; Euphemia Seto
Medicinus Vol 6, No 1 (2016): October 2016 - January 2017
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v6i1.1136

Background: In Indonesia, geriatric population in the year 2005 was 15.8 million (7.2 % population), and expected to reach 11.34% in the year 2020. There was growing evidence for poor sleep as an independent risk factor for poor physical and mental health. Geriatric population may be particularly vulnerable to effects of sleep disturbance due to significant age-related changes in both sleep and inflammatory regulationObjective: To study the epidemiological (gender, age group) and health status (co-morbidities), sleep quality according to Pittsburgh Sleep Quality Index (PSQI) and its associations in geriatric population hospitalized in General Hospital in Karawaci, Tangerang, Banten Province, Indonesia.Materials and Methods: A hospital based cross sectional study was conducted from January to June 2014. A total of 92 subjects aged 60 years and above were selected consecutively from hospitalized geriatric patients for this study. The data was analyzed by means and proportions.Results: The male and female subjects were 51.1% and 48.9%. Mean age was 66.79 + 5.448 years. The age group of 60 – 75 years and above 75 years was 92.4% and 7.6% consecutively. Subjects with diabetes, hypertension, allergy, asthma, cardiac failure and chronic kidney disease were 30.4%, 62.0%, 18.5%, 21.7%, 21.7%, 20.7% consecutively and 63.0% with more than 2 co-morbidities. According to PSQI 72.8% subjects have poor sleep quality. Associations between poor sleep quality to epidemiological and health status were not significant except for diabetes (RR= 3.208 [95% CI: 1.045 – 9.848], p = 0.022) and chronic kidney disease (RR= 6.247 [95% CI: 0.902 – 43.279], p = 0.017)Conclusions: Seventy two percents of subjects have poor sleep quality, and associations between poor sleep quality to epidemiological and health status were not significant except for diabetes.

A Case of Neuropsychiatric Systemic Lupus Erythematosus As A Sequela of Kikuchi’s Disease Theo Audi Yanto; Nathania Raphaeli Mulia; Abraham Fatah
Medicinus Vol 10, No 2 (2022): June 2022 - September 2022
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v10i2.5680

The aetiology of Kikuchi’s Disease (KD), a benign condition associated with multiple lymph node enlargements, remains unknown but several reported cases associate it with systemic lupus erythematosus (SLE). A 34-year-old Indonesian woman presented with multiple painless lymph node enlargements around the neck with three weeks of fever, myalgia, arthralgia, night sweats, and weight loss. Laboratory examination showed pancytopenia and elevated ESR. HIV and tuberculin skin testing were negative. Lymph node biopsy confirmed the diagnosis of KD. One week later, despite improvement in lymphadenopathy, she developed fever. Her ANA, anti-Smith antibodies, and anti-Ribosomal-P protein antibodies were positive. She was diagnosed with SLE and managed as an inpatient with high dose methylprednisolone. One week later, the patient developed psychotic symptoms and fever. The results of Laboratory examinations with lumbar puncture were unremarkable. She was diagnosed with neuropsychiatric SLE (NPSLE) and managed with methylprednisolone, paracetamol, folic acid, alprazolam, and amitriptyline. One month later, the patient returned with three days of fever and dyspnea. Despite improvement in neuropsychiatric symptoms, pneumonia and tonsillopharyngitis were diagnosed based on physical examination and chest X-rays. Her condition deteriorated into septic shock. She suffered cardiac arrest and was pronounced dead, despite attempted resuscitation.While KD is a benign condition, diagnosis is challenging due to its rarity and similarity to other lymphadenopathy diseases. Its association with SLE and NPSLE carries poor prognosis with higher mortality rate from the disease progression and adverse medication effects. Thus, early intervention and prevention of complications are crucial in managing patientswith KD.

Diffuse Large B Cell Lymphoma, Bilateral Lower Extremity Lymphedema, and Ulcerated Inguinal Lymph Node NATA PRATAMA HARDJO LUGITO; ANDREE KURNIAWAN; THEO AUDI YANTO
Indonesian Journal of Cancer Vol 8, No 1 (2014): Jan - Mar 2014
Publisher : National Cancer Center - Dharmais Cancer Hospital

Lymphedema (LE) is a chronic medical condition characterized by lymphatic fluid retention, resulting in tissue swelling. There are two general classifications of LE; primary and secondary which are based on two mechanisms; lymphatic obstruction and lymphatic interruption. The most common cause of LE in the developing world is secondary to an infection known as filariasis. Cancer including Hodgkin and non-Hodgkin lymphomas; and its treatment are some causes of secondary LE. LE also could maintain the persistence of an occult localization of lymphoma. This case illustration describes a female, 57 year-old with stage II lymphedema of both legs, bilateral inguinal lymphadenopathies that were biopsied. The filarial blood examination was negative. Biopsies showed diffuse large B-cell lymphoma.

The Effects of COVID-19 information sources and knowledge, attitude, and behaviour on vaccination acceptance Rivaldo Steven Heriyanto; Theo Audi Yanto; Gilbert Sterling Octavius; Haviza Nisa; Catherine Ienawi; H. Emildan Pasai
Journal of Community Empowerment for Health Vol 6, No 1 (2023)
Publisher : Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jcoemph.78698

This study aimed to assess the impact of COVID-19 information-related sources and people’s knowledge, attitude, and behavior concerning vaccine acceptance, hesitancy, and refusal in a single vaccination site in Jambi, Indonesia. We conducted a cross-sectional study with total sampling in Puskesmas Putri Ayu, Jambi. The inclusion criteria were adults (>18 years) vaccinated with CoronaVac. Our exclusion criteria were refusal to participate in the study for any reason, contraindicated to COVID-19 vaccine administration, and receiving the second vaccine jab. We included 245 respondents with a slight female predominance (53.5%). The majority were in the age group of 26-35 years old (20.8%). In the multivariate analysis, having a family member with ≥2 comorbidities was almost 6 times more likely (OR 5.99, 95%CI: 1.84-19.54;p-value = 0.003) to put a respondent in the vaccine hesitance and refusal group. Respondents who trust in friends or family are 2.25 times more likely (95%CI: 1-5.04; p-value = 0.048) to be in the vaccine hesitance and refusal group. Respondents who trust the internet are 0.45 times more likely to be in the vaccine hesitance and refusal group (95%CI: 0.21-0.96; p-value = 0.04). Lastly, respondents with poor knowledge are 0.58 times more likely (95%CI 0.38-0.88; p-value = 0.011) to belong to the vaccine hesitance and refusal group. This finding will be relevant to increasing vaccination uptake by targeting family members with comorbidities and devising a strategy to make their peers trust the COVID-19 vaccine to increase the uptake.

Demographical risk factors of adverse events following immunisation of CoronaVac in Jambi, Indonesia Heriyanto, Rivaldo; Yanto, Theo Audi; Octavius, Gilbert Sterling; Nisa, Haviza; Ienawi, Catherine; Pasai, Emildan
Public Health and Preventive Medicine Archive Vol. 11 No. 1 (2023)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2023.v11.i1.p05

Background and purpose: Slow uptake of COVID-19 vaccination might be associated with the adverse events after vaccination. This study aims to evaluate the association between demographical factors and COVID-19 vaccine adverse events in Jambi, Indonesia Methods: We conducted a cross-sectional study with a total population sampling. Data were collected with a structured questionnaire. We included adults vaccinated for the first dose with CoronaVac in Putri Ayu Public Health Center between March 15th and June 3rd, 2021, accounted for 522 persons. Statistical analysis was done using IBM SPSS 26.0. Multivariate logistic regression analysis was used to analyze the predictive models. Results: This Out of 522 respondents included, immune reactions (34.1%) were the most common adverse effects reported by the respondents. Multivariate analysis showed that respondents with no family members or friends exposed to COVID-19 are less likely to experience puncture site reaction with an OR of 0.28 (95%CI: 0.09-0.92; p=0.036). Those with no history of mental disorders were also less likely to experience the adverse event with an OR of 0.12 (95%CI: 0.024-0.62; p=0.011). As for other reactions, those in the 26-35 years old category are more likely to experience other adverse event reactions with an OR of 11.62 (95%CI: 1.5-89.92; p=0.019). Conclusion: Based Younger respondents tend to experience more other reaction of COVID-19 vaccine adverse events than the older groups. We also found that those with no family or friends who contracted COVID-19 and no history of mental disorders are less likely to experience puncture site reaction adverse events.

A Case of Neuropsychiatric Systemic Lupus Erythematosus as A Sequela of Kikuchi’s Disease Yanto, Theo Audi; Mulia, Nathania Raphaeli; Fatah, Abraham
Medicinus Vol 12, No 1 (2022): October
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v10i2.7024

The aetiology of Kikuchi’s Disease (KD), a benign condition associated with multiple lymph node enlargements, remains unknown but several reported cases associate it with systemic lupus erythematosus (SLE). A 34-year-old Indonesian woman presented with multiple painless lymph node enlargements around the neck with three weeks of fever, myalgia, arthralgia, night sweats, and weight loss. Laboratory examination showed pancytopenia and elevated ESR. HIV and tuberculin skin testing were negative. Lymph node biopsy confirmed the diagnosis of KD. One week later, despite improvement in lymphadenopathy, she developed fever. Her ANA, anti-Smith antibodies, and anti-Ribosomal-P protein antibodies were positive. She was diagnosed with SLE and managed as an inpatient with high dose methylprednisolone. One week later, the patient developed psychotic symptoms and fever. The results of Laboratory examinations with lumbar puncture were unremarkable. She was diagnosed with neuropsychiatric SLE (NPSLE) and managed with methylprednisolone, paracetamol, folic acid, alprazolam, and amitriptyline. One month later, the patient returned with three days of fever and dyspnea. Despite improvement in neuropsychiatric symptoms, pneumonia and tonsillopharyngitis were diagnosed based on physical examination and chest X- rays. Her condition deteriorated into septic shock. She suffered cardiac arrest and was pronounced dead, despite attempted resuscitation.While KD is a benign condition, diagnosis is challenging due to its rarity and similarity to other lymphadenopathy diseases. Its association with SLE and NPSLE carries poor prognosis with higher mortality rate from the disease progression and adverse medication effects. Thus, early intervention and prevention of complications are crucial in managing patientswith KD.

The Palliative Role of Colchicine on Advanced Hilar Cholangiocarcinoma Patient with Socio-Economic Challenges: A Case Report Yanto, Theo Audi; Mulia, Nathania Raphaeli; Kusuma, Yordan
Medicinus Vol. 14 No. 2 (2025): February
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v14i2.9556

Cholangiocarcinoma is a rare, slow-growing tumor that commonly presents beyond the point of resectability. Current guidelines recommend chemotherapy and radiotherapy for inoperable cases. However, palliative resources are not always accessible for patients with socio-economic barriers. Meanwhile, colchicine is a cost-effective drug and possesses anticancer effects. Here, we present a 53-year-old man with a 6-month history of painless jaundice, severe pruritus, recurrent fever, progressively growing abdominal mass, loss of appetite, and significant weight loss. He was incapable to perform adequate self-care and remained bedridden. Courvoisier sign was noted. Liver function tests show hyperbilirubinemia with elevated CA 19-9 level. Abdominal MRI 3T and MRCP showed hilar cholangiocarcinoma and obliteration of the hepatic vein. The patient and his family did not have health insurance and lived on a minimum income. Considered inoperable, the patient received daily colchicine 1 mg. Within four months, his symptoms have subsided, and he could perform several house chores. Bilirubin also showed a decreasing trend. In neoplastic cells, colchicine inhibits cell mitosis by perturbing tubulin formation. Being widely available, colchicine can be a palliative drug for terminally ill patients with socio-economic challenges. Although it improves patient performance status, we recommend further studies and close monitoring for the use of colchicine in advanced cholangiocarcinoma cases.

Pityriasis Lichenoides et Varioliformis Acuta in Adult Woman with Asymptomatic Bacteriuria: Another Possible Trigger? Yanto, Theo Audi; Mulia, Nathania Raphaeli; Fatah, Abraham; Jayadi, Nana Novia
Majalah Kedokteran Indonesia Vol 73 No 1 (2023): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.73.1-2023-642

Introduction: Pityriasis Lichenoides et Varioliformis Acute (PLEVA) is a rare and benign inflammatory skin disease. This acute form is distinguished from the milder chronic condition, Pityriasis Lichenoides Chronica (PLC). The etiology of PLEVA itself remains unclear, although it has been associated with infection as a trigger.Case: Here, we present the case of a 34-year-old woman who presented with abrupt, generalized, pruritic skin eruptions for two months.Case Discussion: The eruptions started as red scaly papules and vesicles and resolved as hyperpigmentations. She denied having any previous dermatological diseases, routine medications, or vaccinations. On examination, she showed generalized multiple hyperpigmented macules, scaly papules, and vesicles over the trunk, extremities, and face, with erosions and crusts in several areas. Eosinophilia and asymptomatic bacteria were found in her urinalysis. A skin biopsy showed diffuse lymphocytic infiltration in the dermal/epidermal junction and perivascular region, with parakeratosis and lymphocyte exocytosis. While the pathogenesis of PLEVA itself remains unclear, a triggering factor of inflammatory reaction, such as infection, may contribute to the development of the disease.Conclusion: Asymptomatic bacteriuria is associated with inflammatory responses, and thus, it can be one of many possibilities. More studies are needed to confirm this association with PLEVA. Due to the lack of a clear pathogenesis and the benign nature of the disease, this rare entity may present difficulties in diagnosis and therapy

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