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All Journal Journal of General Procedural Dermatology and Venereology Indonesia Folia Medica Indonesiana
Effendy, Isaak
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Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Neuroscience

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TORCH Re-activation Concomitant with Drug-induced Hypersensitivity Syndrome Shows Erythema Multiforme-like and Vasculitis Clinical Features Budianti, Windy Keumala; Rihatmadja, Rahadi; Aulia, Izzah; Effendy, Isaak
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 6, No. 2
Publisher : UI Scholars Hub

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Background: Drug-induced hypersensitivity syndrome (DIHS) can be associated with cytomegalovirus (CMV) infection, besides induced by drugs. We report a case of DIHS with prolonged atypical clinical features and vasculitis precipitated by drug allergy, CMV, and other viral infections. Case illustration: A 54-year-old female presented with generalized follicular erythematous papules and waxy palmoplantar keratoderma since one month before admission. The symptoms started as a purpuric lesion on the upper extremities, spreading as erythematous papules on the trunk with facial edema, accompanied by fever and chronic cough. She had been previously treated with ambroxol and cephalosporin. Cutaneous drug allergy reaction was assessed. Although in therapy with systemic corticosteroids, lesions still appeared and became confluent, with new palpable purpura on the extremities. Histopathology showed interface dermatitis, consisting of lymphocytes and plasma cells but lacking eosinophils, leukocytoclastic vasculitis, and numerous dyskeratotic keratinocytes. The possibility of systemic infection was sought, and TORCH examination suggested acute and latent infection. The patient had a positive PCR for CMV. Intravenous ganciclovir 500 mg/day for three weeks and a low dose of systemic corticosteroids led to complete cessation of skin and pulmonary symptoms. Discussion: The clinical and histopathological examination was consistent with erythema multiforme. Therefore, high titer of IgM and IgG anti-CMV, and excellent response to ganciclovir supported our suspicion of an infection-induced process. The infection might be precipitated by a drug allergy. Conclusion: CMV-associated skin lesion could be precipitated by drug hypersensitivity, resulting in erythema multiforme-like clinical features with vasculitis. Severe systemic involvement related to CMV reactivation. Early anti-CMV therapy showed good improvement and reduce risk of mortality.
The Histopathological Features of Syphilis and Its Mimickers Purnamasari, Indah; Hidayati, Afif Nurul; Kusumastuti, Etty Hary; Effendy, Isaak
Folia Medica Indonesiana Vol. 59, No. 1
Publisher : Folia Medica Indonesiana

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Highlights: • The importance of having a strong suspicion for syphilis and maintaining close contact between dermatologists and pathologists cannot be understated. • Understanding the clinical relationship and histopathological features of syphilis is crucial for accurate diagnosis and distinction from its histopathologic mimickers. Abstract: Settings Syphilis, also known as "the great imitator," is a sexually transmitted infection with a variety of clinical symptoms and histopathological similarities to other infectious diseases. Public health concerns about syphilis have grown significantly. Since 2000, there has been an increase in syphilis prevalence in the United States, with a 17.6% increase from 2015 to 2016. From 2000 to 2019, the number of syphilis cases throughout Asia increased from 0.9% to 30.9%, whilst the number of cases in Indonesia decreased from 22.5% to 14.4%. Specific serological tests for syphilis can usually detect and confirm the diagnosis and offer follow-up care in most cases. However, in certain instances, the clinical characteristics discovered during testing can be identical to those of other diseases, which may lead to inconsistent diagnosis. Considering that the diagnostic pathology is pertinent to the clinical circumstances, a histopathological investigation may be useful for differentiating syphilis mimickers. Pathology is essential for identifying potential syphilis patients with ambiguous clinical symptoms. This study's purpose was to assist dermatologists and pathologists in identifying "mimickers" that require a biopsy and in determining the correct diagnosis and treatment coutsed based on etiology.
Co-Authors Afif Nurul Hidayati, Afif Nurul Aulia, Izzah Indah Purnamasari KUSUMASTUTI, ETTY HARY Rahadi Rihatmadja Windy Keumala Budianti