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Erythema Nodosum Leprosum as a Harbinger of Relapse in Multibacillary Leprosy: A Clinico-Histopathological Case Study Benedikta Lauda; Nurrachmat Mulianto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (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.v9i12.1468

Background: Leprosy, a chronic granulomatous disease caused by Mycobacterium leprae, presents formidable long-term management challenges. In the post-elimination era, differentiating a true bacteriological relapse from a late-onset Erythema Nodosum Leprosum (ENL) reaction in patients who have completed multidrug therapy (MDT) is a critical diagnostic dilemma. Misdiagnosis can lead to inappropriate treatment, risking disease progression and irreversible nerve damage. Case presentation: A 30-year-old male presented with a severe, systemic inflammatory illness two years after completing MDT for lepromatous leprosy. His symptoms included crops of painful, erythematous nodules, fever, and arthralgia. While clinically suggestive of a severe ENL reaction, a slit-skin smear revealed a paradoxically high bacterial index (BI) of +5 with a morphological index (MI) of 0%. A skin biopsy was performed for definitive diagnosis. Histopathology revealed a dual pathology: a diffuse infiltrate of foamy macrophages typical of lepromatous leprosy, alongside a dense neutrophilic panniculitis characteristic of ENL. Crucially, Fite-Faraco staining demonstrated vast numbers of intact, solid-staining acid-fast bacilli, providing unequivocal evidence of active bacterial proliferation. Conclusion: This case demonstrates that a diagnostic algorithm integrating a high index of clinical suspicion with comprehensive bacteriological and histopathological methods is essential for accurately identifying relapse masked by ENL. The presence of viable bacilli confirms that ENL can be a direct clinical harbinger of relapse, mandating a dual therapeutic strategy that combines aggressive anti-inflammatory treatment with the immediate re-initiation of MDT.

Dose- and Time-Dependent Efficacy of Topical Hydroquinone in Establishing a C57BL/6 Mouse Model of Vitiligo Benedikta Lauda; Nurrachmat Mulianto; Endra Yustin Ellistasari; Muhammad Eko Irawanto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1481

Background: Vitiligo is a complex autoimmune depigmenting disorder driven by melanocyte-specific CD8+ T cells, oxidative stress, and genetic susceptibility. The lack of standardized, accessible animal models that recapitulate these pathways hinders therapeutic development. This study aimed to systematically optimize and validate a chemically-induced vitiligo model in C57BL/6 mice. Methods: Eighty (80) male C57BL/6 mice were randomized into ten groups (n=8/group). Experimental groups received once-daily topical applications of hydroquinone (HQ) at 2.5%, 5%, or 10%, or monobenzone (MBZ) at 40% for 8 or 16 days. Vehicle-treated mice served as controls. Efficacy was assessed via quantitative histopathology (Masson-Fontana staining for melanin area), biomolecular assays for oxidative stress (Malondialdehyde [MDA] and Superoxide Dismutase [SOD]), and RT-qPCR for melanogenesis-related (Tyr) and inflammation-related (Tnf) gene expression. Results: A clear dose- and time-dependent depigmentation was observed. The 10% HQ 16-day protocol was maximally effective, inducing a profound reduction in epidermal melanin area (0.06 ± 0.02) compared to 16-day controls (0.40 ± 0.04; p < 0.001). This histopathological finding was significantly correlated with severe cutaneous oxidative stress, evidenced by a 3.75-fold increase in MDA (p < 0.001) and a 50% reduction in SOD activity (p < 0.001) versus controls. Furthermore, this regimen caused a potent suppression of Tyr expression (0.15-fold change; p < 0.001) and a significant upregulation of the pro-inflammatory cytokine Tnf (3.8-fold change; p < 0.001). Conclusion: The 16-day topical application of 10% hydroquinone is a reliable, rapid, and highly reproducible protocol for inducing vitiligo-like depigmentation in C57BL/6 mice. This model successfully recapitulates key pathophysiological pillars of human vitiligo, including melanocytotoxicity, profound oxidative stress, and a pro-inflammatory cutaneous environment, establishing it as a valuable platform for preclinical therapeutic screening.

Onychomycosis with Green Nail Discoloration in an Immunocompromised Patient: A Case Report Mulianto, Nurrachmat; Oktaviani, Trya
Health and Medical Journal Vol 7, No 3 (2025): HEME September 2025
Publisher : Universitas Baiturrahmah

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33854/heme.v7i3.1816

Candida onychomycosis is an infection of the nails of the hands or feet caused by Candida sp. Green nail discoloration (GND) is a greenish discoloration of the nail due to bacterial infection, fungal infection or polymicrobial infection. Candida species fungi are fungal pathogens reported to be associated with GND. A 22-year-old female complained of greenish-yellow colored right thumb nail since 3 months ago. The patient has a history of systemic lupus erythematosus (SLE) since 1 year ago. Dermatological status examination of the digiti I manus dexter region showed onychodystrophy, subungual hyperkeratosis and greenish yellow discoloration of the nail plate. Based on the results of history, physical examination and supporting examination, the patient was diagnosed onychomycosis with GND. The diagnosis of onychomycosis can be established by history taking, physical examination and supporting examination in the form of dermoscopy, microscopic nail scraping with 20% KOH, fungal culture and nail biopsy with Periodic Acid-Schiff's (PAS) histochemical painting. Green nail discoloration is one of the clinical manifestations in cases of onychomycosis. Candida sp. is reported as one of the fungal pathogens associated with GND. Management of onychomycosis requires a long time and aims to eliminate fungal pathogens and improve nail condition.

Combination Therapy of Topical Antioxidant Gel and Platelet-Rich Plasma (PRP) in Pyoderma Gangrenosum Ulcer: A Case Report Kamilah, Lian; Bobby Febrianto; Nurrachmat Mulianto; Nugrohoaji Dharmawan; Harijono Kariosentono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (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.v8i8.1046

Background: Pyoderma gangrenosum (PG) is a rare necrotic ulcerative skin disease, often associated with an underlying systemic condition. Bacterial coinfection in PG can worsen the course of the disease and slow healing. Case presentation: We report the case of a 25-year-old woman with PG of her left leg complicated by Pseudomonas aeruginosa co-infection. The patient had a history of poorly treated psoriasis. The diagnosis is made based on disease history, physical examination, microbiological examination, and histopathological examination. The patient was treated with oral levofloxacin and topical combination therapy of astaxanthin and platelet-rich plasma (PRP) with wound debridement. Significant clinical improvement was achieved within six weeks. Conclusion: PG with bacterial coinfection requires appropriate diagnosis and treatment to achieve optimal results. Topical therapy combining astaxanthin and PRP with wound debridement proved effective in this case.

Combination Therapy of Topical Antioxidant Gel and Platelet-Rich Plasma (PRP) in Pyoderma Gangrenosum Ulcer: A Case Report Kamilah, Lian; Bobby Febrianto; Nurrachmat Mulianto; Nugrohoaji Dharmawan; Harijono Kariosentono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (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.v8i8.1046

Background: Pyoderma gangrenosum (PG) is a rare necrotic ulcerative skin disease, often associated with an underlying systemic condition. Bacterial coinfection in PG can worsen the course of the disease and slow healing. Case presentation: We report the case of a 25-year-old woman with PG of her left leg complicated by Pseudomonas aeruginosa co-infection. The patient had a history of poorly treated psoriasis. The diagnosis is made based on disease history, physical examination, microbiological examination, and histopathological examination. The patient was treated with oral levofloxacin and topical combination therapy of astaxanthin and platelet-rich plasma (PRP) with wound debridement. Significant clinical improvement was achieved within six weeks. Conclusion: PG with bacterial coinfection requires appropriate diagnosis and treatment to achieve optimal results. Topical therapy combining astaxanthin and PRP with wound debridement proved effective in this case.

An Unusual Case of Pemphigus Foliaceus Arising in a Patient with Psoriasis Vulgaris Nurrachmat Mulianto; Osdatilla Esa Putri
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 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.v9i2.1190

Background: Pemphigus foliaceus (PF) is a rare autoimmune blistering disease characterized by superficial, fragile blisters. Psoriasis vulgaris, a chronic inflammatory skin condition, has been rarely associated with PF. This case report presents an unusual instance of PF developing in a patient with a history of psoriasis vulgaris. Case presentation: A 54-year-old Indonesian woman presented with a one-year history of scaly skin and reddish spots across her body, worsening over the past week. She had a prior diagnosis of psoriasis vulgaris and was undergoing methotrexate therapy (15 mg/week) without significant improvement. Three months prior, she developed loose blisters on her back that spread to her hands, rupturing easily and leaving painful sores. The patient denied any mucosal involvement. One week before her presentation, her symptoms worsened following relocation-related stress. Dermatological examination revealed generalized multiple erythematous patches with scales, some with ruptured blisters leaving erosions, and a positive Nikolsky sign. Histopathological examination confirmed PF. The patient was treated with intravenous methylprednisolone, oral erythromycin and paracetamol, topical mupirocin, and clobetasol. After one month, due to a lack of improvement, azathioprine was added, leading to lesion improvement without side effects. Conclusion: This case highlights the rare but potential development of PF in patients with psoriasis vulgaris. The complex interplay between these two conditions warrants further investigation. Early diagnosis and appropriate treatment are crucial for managing PF and improving patient outcomes.

Deep Mycosis in Central Java, Indonesia: Occupational Risk Factors and Diagnostic Challenges in a Single Center Dr. Moewardi General Hospital Nurrachmat Mulianto; Ivani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 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.v9i2.1192

Background: Deep mycosis, a spectrum of invasive fungal infections affecting deeper tissues, poses significant diagnostic and therapeutic challenges, particularly in tropical regions like Central Java, Indonesia. This study aimed to investigate the epidemiological trends, occupational risk factors, and diagnostic challenges associated with deep mycosis in this region. Methods: A retrospective study was conducted at a single center, Dr. Moewardi General Hospital, in Central Java, Indonesia, analyzing medical records of patients diagnosed with deep mycosis between 2019 and 2024. Data on demographics, occupation, clinical presentation, diagnostic methods, and treatment outcomes were collected and analyzed. Results: A total of 12 cases of deep mycosis were identified. The majority of patients were male (75%) and engaged in agricultural activities (50%). Chromoblastomycosis (66.7%) and maduromycosis (25%) were the most common clinical diagnoses. Diagnostic delays were frequent (mean delay: 5.1 months), primarily due to non-specific clinical presentations and limited access to diagnostic facilities. Conclusion: Deep mycosis predominantly affects individuals involved in agriculture in Central Java, highlighting the need for enhanced awareness and preventive strategies among high-risk occupational groups. Improved diagnostic facilities and healthcare infrastructure are crucial for timely diagnosis and effective management of deep mycosis in resource-constrained settings.

Dose- and Time-Dependent Efficacy of Topical Hydroquinone in Establishing a C57BL/6 Mouse Model of Vitiligo Benedikta Lauda; Nurrachmat Mulianto; Endra Yustin Ellistasari; Muhammad Eko Irawanto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i1.1481

Background: Vitiligo is a complex autoimmune depigmenting disorder driven by melanocyte-specific CD8+ T cells, oxidative stress, and genetic susceptibility. The lack of standardized, accessible animal models that recapitulate these pathways hinders therapeutic development. This study aimed to systematically optimize and validate a chemically-induced vitiligo model in C57BL/6 mice. Methods: Eighty (80) male C57BL/6 mice were randomized into ten groups (n=8/group). Experimental groups received once-daily topical applications of hydroquinone (HQ) at 2.5%, 5%, or 10%, or monobenzone (MBZ) at 40% for 8 or 16 days. Vehicle-treated mice served as controls. Efficacy was assessed via quantitative histopathology (Masson-Fontana staining for melanin area), biomolecular assays for oxidative stress (Malondialdehyde [MDA] and Superoxide Dismutase [SOD]), and RT-qPCR for melanogenesis-related (Tyr) and inflammation-related (Tnf) gene expression. Results: A clear dose- and time-dependent depigmentation was observed. The 10% HQ 16-day protocol was maximally effective, inducing a profound reduction in epidermal melanin area (0.06 ± 0.02) compared to 16-day controls (0.40 ± 0.04; p < 0.001). This histopathological finding was significantly correlated with severe cutaneous oxidative stress, evidenced by a 3.75-fold increase in MDA (p < 0.001) and a 50% reduction in SOD activity (p < 0.001) versus controls. Furthermore, this regimen caused a potent suppression of Tyr expression (0.15-fold change; p < 0.001) and a significant upregulation of the pro-inflammatory cytokine Tnf (3.8-fold change; p < 0.001). Conclusion: The 16-day topical application of 10% hydroquinone is a reliable, rapid, and highly reproducible protocol for inducing vitiligo-like depigmentation in C57BL/6 mice. This model successfully recapitulates key pathophysiological pillars of human vitiligo, including melanocytotoxicity, profound oxidative stress, and a pro-inflammatory cutaneous environment, establishing it as a valuable platform for preclinical therapeutic screening.

Tatalaksana Platelet Rich Plasma Pada Pasien Chronic Venous Leg Ulcer Adjie, Sugih Primas; Kariosentono, Harijono; Mulianto, Nurrachmat; Dharmawan, Nugrohoaji; Primisawitri, Pratiwi Prasetya
Jurnal Locus Penelitian dan Pengabdian Vol. 4 No. 12 (2025): JURNAL LOCUS: Penelitian dan Pengabdian
Publisher : Riviera Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58344/locus.v4i12.4872

Latar belakang: Ulkus kronis pada ekstremitas bawah salah satunya yaitu ulkus venosum. Ulkus venosum didefinisikan sebagai lesi terbuka antara sendi lutut dan pergelangan kaki yang terjadi karena penyakit vena. Tantangan dalam mengobati VLU adalah kekambuhan yang sering terjadi maka terapi luka tingkat lanjut harus dipertimbangkan. Platelet rich plasma (PRP) sebagai terapi adjuvan pengobatan ulkus venosum dan menunjukkan hasil yang menjanjikan. Kasus: Seorang laki-laki berusia 55 tahun dengan keluhan luka yang sulit sembuh sejak dua tahun yang lalu. Pemeriksaan status dermatovenereologi pada regio ekstremitas inferior desktra nampak ulkus multipel dengan ukuran terbesar 9 cm x 5 cm x 0.5 cm, dengan dasar eritem dan serum tanpa disertai pus, nekrosis, nekrotik dan darah. Pasien memiliki riwayat hipertensi dan obesitas derajat II dengan Indeks Masa Tubuh (IMT) 44,29. Pasien diberikan terapi Platelet Rich Plasma (PRP) setiap tujuh hari, Kompres luka dengan cairan NaCl 0,9% selama 10 menit dilanjutkan dengan mupirosin 2% salep dan ditutup dengan menggunakan plester hidrokoloid yang dilakukan per 24 jam. Evaluasi pada minggu ke-6 terapi PRP, pasien menunjukkan adanya perbaikan klinis pada luka. Diskusi: Kandungan PRP terdiri dari banyak faktor pertumbuhan untuk mempercepat penyembuhan luka dan angiogenesis. Trombosit mengandung faktor pertumbuhan yang memicu efek biologis yang merupakan kunci dalam proses perbaikan dan regenerasi jaringan.

Hubungan Derajat Keparahan dengan Status Psikososial Pasien Melasma : Studi Cross-sectional Sambodo, Shelly Lavenia; Ellistasari, Endra Yustin; Kusumawardani, Arie; Irawanto, Muhammad Eko; Mulianto, Nurrachmat
Jurnal Locus Penelitian dan Pengabdian Vol. 4 No. 12 (2025): JURNAL LOCUS: Penelitian dan Pengabdian
Publisher : Riviera Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58344/locus.v4i12.4993

Melasma tidak hanya berdampak pada aspek fisik berupa hiperpigmentasi, tetapi juga menimbulkan gangguan psikososial yang signifikan. Hubungan antara tingkat keparahan klinis melasma dengan derajat gangguan psikososial belum banyak diteliti di populasi Indonesia. Menganalisis hubungan antara tingkat keparahan melasma menggunakan Melasma Area and Severity Index (MASI) dengan derajat status psikososial menggunakan Melasma Quality of Life (MELASQOL). Studi cross-sectional dilakukan pada 15 pasien wanita dengan melasma di RSUD Dr. Moewardi Surakarta. Tingkat keparahan dinilai menggunakan skor MASI, sedangkan status psikososial dinilai menggunakan kuesioner skor MELASQOL. Analisis korelasi Pearson dan regresi linear sederhana digunakan untuk mengevaluasi hubungan antar variabel. Rerata skor MASI adalah 5,95±1,15 dengan 53,3% pasien memiliki tingkat keparahan sedang dan 46,7% dengan tingkat derajat berat. Rerata skor MELASQOL adalah 40,33±6,22 dengan distribusi yang sama. Terdapat korelasi positif sangat kuat antara skor MASI dan MELASQOL (r=0,988; p<0,001; R²=0,977). Persamaan regresi menunjukkan MELASQOL = 8,62 + 5,33 × MASI. Terdapat hubungan positif yang sangat kuat antara tingkat keparahan melasma dengan derajat gangguan psikososial.

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