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All Journal Syifa' MEDIKA: Jurnal Kedokteran dan Kesehatan Bali Dermatology Venereology and Aesthetic Journal
Roslina, Nina
Unknown Affiliation
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Neurosifilis Asimtomatik Pada Pasien Sifilis Sekunder Dengan Koinfeksi Human Immunodeficiency Virus Febrina, Dia; Cahyawari, Dartri; Roslina, Nina; Rowawi, Rasmia; Achdiat, Pati Aji
Syifa'Medika Vol 8, No 1 (2017): Syifa' MEDIKA: Jurnal Kedokteran dan Kesehatan
Publisher : Faculty of Medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32502/sm.v8i1.1353

Abstract

Neurosifilis merupakan infeksi pada sistem saraf pusat yang disebabkan invasi sawar darah otak oleh Treponema pallidum yang umumnya terjadi pada pasien sifiis koinfeksi dengan human immunodeficiency virus (HIV). Neurosifilis umumnya terjadi pada sifilis tersier, tetapi dapat pula terjadi pada stadium lainnya, termasuk stadium sekunder. Diagnosis neurosifilis asimtomatik ditegakkan apabila didapatkan serum venereal disease research laboratory (VDRL) yang positif tanpa tanda dan gejala neurologis disertai satu dari karakteristik berikut pada pemeriksaan liquor cerebrospinal (LCS): (1) jumlah leukosit > 10/mm3; (2) protein total > 50 mg/dL; (3) hasil VDRL reaktif. Dilaporkan seorang pasien laki-laki berusia 35 tahun dengan sifilis sekunder koinfeksi HIV tanpa ditemukannya tanda dan gejala neurologis. Kecurigaan neurosifilis pada pasien ini disebabkan oleh kegagalan terapi pada sifilis sekunder, status HIV dengan jumlah CD4+ 106/mm3, dan serum VDRL 1:256. Diagnosis neurosifilis pada laporan kasus ini ditegakkan berdasarkan pemeriksaan LCS yang menunjukkan hasil VDRL yang reaktif, peningkatan jumlah leukosit dan protein total. Pasien ini diberikan penisilin G prokain 2,4 juta unit tanpa probenesid yang diberikan secara intramuskular selama 14 hari. Pada pasien sifilis koinfeksi HIV dapat dicurigai neurosifilis apabila ditemukan salah satu karakteristik berikut: (1) tidak terjadi penurunan titer VDRL setelah terapi benzatin penisilin; (2) serum VDRL/rapid plasma reagin (RPR) ? 1:32; (3) jumlah CD4+ < 350 sel/mm3. Kegagalan terapi pada sifilis sekunder dapat disebabkan oleh infeksi Treponema pallidum pada sistem saraf pusat. Simpulan, dilaporkan satu pasien usia 35 tahun dengan neurosifilis asimtomatik yang diberikan terapi penisilin G prokain 2,4 juta unit tanpa probenesid selama 14 hari. Pemeriksaan serum VDRL pada bulan ketiga pasca terapi belum mengalami penurunan titer.
Drug reaction with eosinophilia and systemic symptoms (DRESS) with acute kidney injury and transaminitis: A rare case Luziani, Stefani; Roslina, Nina; Zakaria, Rio; Sumarmi
Bali Dermatology Venereology and Aesthetic Journal BDVAJ - Volume 8, Issue 1 (2025)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/balidervenaesthj.v8i1.108

Abstract

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, serious, and potentially life-threatening drug hypersensitivity reaction. The diagnosis of DRESS can be challenging to make because of the highly variable clinical presentation, progressive onset of manifestations, and the extended period from drug exposure to onset. Many DRESS cases remain undiagnosed or misdiagnosed. This study aims to report a rare case of an adult patient with DRESS to expand our knowledge and avoid delayed identification and treatment. Case: A 31-year-old male presented to the emergency department with a chief complaint of itchy, red desquamation rashes all over his body, with fever and swelling on his face. The dermatological status obtained was a generalized distribution; on nearly the entire body surface area, there were multiple lesions, confluent, with unclear boundaries, irregular in shape, plaque-sized, not raised, dry, in the form of erythematous macules with scales and light yellow crusts. Hematological laboratory analysis revealed hypereosinophilia. The renal function indicated a decreased eGFR of over 75%, and the hepatic function test revealed an elevated in liver function. The patient was diagnosed with DRESS, acute kidney injury, and transaminitis. There was an improvement in the patient's condition following the withdrawal of the previous medications and the administration of intravenous dexamethasone, oral antihistamine, and symptomatic treatment. Conclusion: Early identification and withdrawal of all suspected medications are essential for the management of DRESS, as a delayed diagnosis can be life-threatening. The administration of systemic steroids is efficacious for the treatment of DRESS.
Co-Authors Cahyawari, Dartri Febrina, Dia Luziani, Stefani Pati Aji Achdiat Rasmia Rowawi Rio Zakaria Sumarmi