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Damayanti Tangkidi, Damayanti
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FASIITIS NEKROTIKAN TIPE II Sondakh, Oktavia R. L.; Tangkidi, Damayanti; Pandaleke, Herry E. J.
Jurnal Biomedik : JBM Vol 7, No 3 (2015): JURNAL BIOMEDIK : JBM Suplemen
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.7.3.2015.10443

Abstract

Abstract: Necrotizing fasciitis, often called flesh eating bacteria, is a progressive necrosis in subcutaneous fat and fascia. Type II necrotizing fasciitis caused by Acinetobacter baumannii is rarely found. Predisposing factors of necrotizing fasciitis include elderly, immunocompromised condition, chronic diseases, alcoholism, and trauma. We reported a case of a 68-year-old male complained of dark red swelling accompanied by pain in the left thigh. On examination of the left femoral region, there was a diffuse macula, plaque sized, erythematous to black colored, with erosion, excoriation, and necrotic tissue. Hematological examination showed the LRINEC score of 6. The pus culture result was Acinetobacter baumannii. The patient was given systemic antibiotics and debriedement was performed. The lesion did not extend anymore and the patient's general condition became better. Post debridement, the ulcer was treated with hydrogel wound dressings containing honey. After 60 days, the ulcer healed with a hypertrophic scar. Conclusion: This case was diagnosed as type II necrotizing fasciitis caused by Acinetobacter baumannii based on anamnesis, physical examination, hematological examination, and pus culture which were typical for this diagnosis.Keywords: type II necrotizing fasciitis, LRINEC scoreAbstrak: Fasiitis nekrotikan (FN) atau sering disebut “flesh eating bacteria” adalah nekrosis progresif di lemak sub kutan dan fasia. Fasiitis nekrotikan tipe II yang disebabkan oleh Acinetobacter baumanii jarang ditemukan. Faktor predisposisi FN antara lain usia lanjut, imunokompromais, penyakit kronik, alkoholisme, dan trauma. Kami melaporkan seorang laki-laki berusia 68 tahun dengan bengkak merah kehitaman yang disertai nyeri di paha kiri. Pada pemeriksaan regio femoralis sinistra terdapat makula difus, ukuran plakat, eritem sampai kehitaman, disertai erosi, eskoriasi, dan jaringan nekrotik. Pemeriksaan hematologik menunjukkan skor LRINEC 6. Hasil kultur pus ialah Acinetobacter baumanii. Pasien mendapatkan antibiotik sistemik dan dilakukan debrideman. Lesi tidak meluas dan keadaan umum pasien baik setelah penanganan dengan antibiotik dan debrideman. Ulkus paska debrideman dirawat dengan balutan luka hidrogel mengandung madu. Ulkus sembuh dengan meninggalkan skar hipertrofik setelah 60 hari. Simpulan: Pada kasus ini, diagnosis fasiitis nekrotikan tipe II yang disebabkan oleh Acinetobacter baumanii ditegakkan berdasarkan anamnesis, pemeriksaan fisik, pemeriksaan hematologik, dan kultur pus yang khas.Kata kunci: fasiitis nekrotikan tipe II, skor LRINEC
MORBUS HANSEN MULTIBASILER RELAPS DENGAN REAKSI ERITEMA NODOSUM LEPROSUM BULOSA PADA SEORANG ANAKMORBUS HANSEN MULTIBASILER RELAPS DENGAN REAKSI ERITEMA NODOSUM LEPROSUM BULOSA PADA SEORANG ANAK Tangkidi, Damayanti; Sondakh, Oktavia R. L.; Kandou, Renate T.
JURNAL BIOMEDIK : JBM Vol 7, No 3 (2015): JURNAL BIOMEDIK : JBM
Publisher : UNIVERSITAS SAM RATULANGI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/jbm.7.3.2015.9491

Abstract

Abstract: The clinical manifestations of ENL bullous reaction are generally in the form of nodes and erythematous plaques, but in a severe reaction, bullae, ulcerations, and necrosis may occur. Relapses occur one year or more after the RFT whilst the symptoms emerge slowly and gradually. We reported a case of multibacillary leprosy relapse with ENL bullous reaction in a 14-year-old boy. The clinical picture consisted of reddish nodes and thickening red plaques since 10 days before admission to the hospital, followed by fluid-filled blisters associated with fever. The dermatological status showed multiple erythematous nodes and plaques, as well as multiple bullae. The laboratory tests indicated AFB (+), MI 6.5%, and BI 4+. The patient was stated as RFT after 1 year of MDT-MB treatment. The patient was treated with methylprednisolone 1x40 mg intravenous injection for 10 days, followed by oral methylprednisolone 4 mg in reduced dosage. Conclusion: This case was diagnosed as MHMB relapse with ENL bullous reaction based on the anamnesis, clinical features such as multiple erythematous nodules and plaques with bullae, and laboratory tests. Treatment with corticosteroids and MDT-MB resulted in good improvement.Keywords: ENL bullous reaction, relapseAbstrak: Manifestasi klinis reaksi ENL bulosa umumnya berupa nodi dan plak eritematosa, namun pada reaksi berat dapat berupa bula, ulserasi, dan nekrosis. Relaps terjadi 1 tahun atau lebih setelah RFT, dimana gejala timbul lambat dan bertahap. Kami melaporkan suatu kasus MHMB relaps dengan reaksi ENL bulosa pada seorang anak berusia 14 tahun. Gambaran klinis didapatkan bentol kemerahan dan bercak merah meninggi sejak 10 hari lalu, kemudian timbul lepuh berisi cairan disertai demam badan. Status dermatologis generalisata ditemukan nodul dan plak eritematosa multipel serta bula multipel. Pemeriksaan laboratorium menunjukkan BTA (+), MI 6,5%, dan BI 4+. Pasien dinyatakan RFT setelah 1 tahun pengobatan MDT-MB. Pasien diobati dengan metilprednisolon injeksi 1x40 mg intravena selama 10 hari, dilanjutkan dengan metilprednisolon oral 4mg dengan dosis diturunkan. Lesi bulosa pada kusta merupakan manifestasi dari reaksi ENL berat dengan MI dan BI yang tinggi. Simpulan: Pada kasus ini, diagnosis MHMB relaps dengan reaksi ENL bulosa ditegakkan berdasarkan anamnesis, gambaran klinis berupa nodul dan plak eritematosa multipel disertai bula, dan pemeriksaan laboratorik. Pengobatan dengan kortikosteroid dan MDT-MB memberikan hasil yang baik.Kata kunci: reaksi ENL bulosa, relaps