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From Patches to Plaques: A Diagnostic Challenge in a Case of Erythroderma Secondary to Pityriasis Rubra Pilaris Kamilah, Lian; Rahmat Firdaus Dwi Utama; Shelly Lavenia Sambodo; Muhammad Eko Irawanto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 6 (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.v9i6.1297

Background: Erythroderma, a dramatic and potentially life-threatening condition characterized by fiery redness engulfing over 90% of the skin's surface, presents a formidable diagnostic challenge due to its myriad underlying causes. Among these, pityriasis rubra pilaris (PRP), a rare inflammatory skin disorder, stands out with its distinctive features and often perplexing presentation. This case unveils the intricate diagnostic journey of a young man whose erythroderma masked an underlying PRP, further complicated by the subtle interplay of stress. Case presentation: An 18-year-old male presented with a one-month history of alarming erythroderma accompanied by distressing itching, fever, and sleep disturbances. Adding to the complexity, he exhibited characteristic 'nappes claires' – islands of normal skin amidst the erythrodermic sea – a hallmark of PRP. Palmoplantar keratoderma, alopecia areata, and ectropion further painted an intriguing clinical picture. Histopathological examination revealed the telltale 'checkboard' pattern, confirming PRP as the culprit. Notably, the patient's history revealed a compelling link between stress and disease exacerbation, adding a psychosomatic dimension to the case. Systemic corticosteroids and methotrexate, alongside topical emollients, brought about significant clinical improvement, underscoring the importance of early diagnosis and targeted treatment. Conclusion: This case underscores the critical need to consider PRP in the labyrinth of erythroderma diagnoses, particularly when 'nappes claires' and a history of stress are intertwined. By shining a light on the diagnostic subtleties and therapeutic nuances of PRP-associated erythroderma, this report empowers clinicians to navigate the complexities of this rare and challenging condition, ultimately improving patient outcomes and quality of life.

From Patches to Plaques: A Diagnostic Challenge in a Case of Erythroderma Secondary to Pityriasis Rubra Pilaris Kamilah, Lian; Rahmat Firdaus Dwi Utama; Shelly Lavenia Sambodo; Muhammad Eko Irawanto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 6 (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.v9i6.1297

Background: Erythroderma, a dramatic and potentially life-threatening condition characterized by fiery redness engulfing over 90% of the skin's surface, presents a formidable diagnostic challenge due to its myriad underlying causes. Among these, pityriasis rubra pilaris (PRP), a rare inflammatory skin disorder, stands out with its distinctive features and often perplexing presentation. This case unveils the intricate diagnostic journey of a young man whose erythroderma masked an underlying PRP, further complicated by the subtle interplay of stress. Case presentation: An 18-year-old male presented with a one-month history of alarming erythroderma accompanied by distressing itching, fever, and sleep disturbances. Adding to the complexity, he exhibited characteristic 'nappes claires' – islands of normal skin amidst the erythrodermic sea – a hallmark of PRP. Palmoplantar keratoderma, alopecia areata, and ectropion further painted an intriguing clinical picture. Histopathological examination revealed the telltale 'checkboard' pattern, confirming PRP as the culprit. Notably, the patient's history revealed a compelling link between stress and disease exacerbation, adding a psychosomatic dimension to the case. Systemic corticosteroids and methotrexate, alongside topical emollients, brought about significant clinical improvement, underscoring the importance of early diagnosis and targeted treatment. Conclusion: This case underscores the critical need to consider PRP in the labyrinth of erythroderma diagnoses, particularly when 'nappes claires' and a history of stress are intertwined. By shining a light on the diagnostic subtleties and therapeutic nuances of PRP-associated erythroderma, this report empowers clinicians to navigate the complexities of this rare and challenging condition, ultimately improving patient outcomes and quality of life.

The Crescendo Reaction in Patch Testing: A Key Diagnostic Sign in Allergic Contact Cheilitis from Modern Matte Lipsticks Rahmat Firdaus Dwi Utama; Harijono Kariosentono; Ayu Kusuma Dewi; Shelly Lavenia Sambodo; Stella Gracia Octarica; Sugih Primas Adjie
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.798

Allergic contact cheilitis (ACC) from lipsticks is a frequent diagnostic challenge, often mimicking irritant contact cheilitis (ICC). The patch test is the diagnostic standard, but its accuracy relies heavily on the interpretation of reaction dynamics over time. This report illustrates the pivotal role of the crescendo reaction pattern in confirming an allergic etiology. A 21-year-old female presented with a six-month history of debilitating pruritus, papules, and subsequent xerosis with severe post-inflammatory hyperpigmentation on her lips. The symptoms were directly correlated with the daily use of several popular commercial matte and long-lasting lipsticks. Patch testing was performed with the European Standard Series and the patient’s own cosmetic products. While standard allergens were negative, three specific lipsticks elicited a classic crescendo reaction: a weak positive (+) erythema at 48 hours that intensified to a strong positive (++) reaction with papules and palpable infiltration at the 72- and 96-hour readings. This dynamic confirmed a Type IV hypersensitivity reaction and a diagnosis of ACC. Management focused on strict allergen avoidance and barrier repair, resulting in complete resolution of symptoms and significant improvement in her quality of life. In conclusion, the crescendo pattern observed in patch testing is a compelling in vivo marker of an allergic, memory T-cell-driven immune response. Its presence provides conclusive evidence for ACC, reliably distinguishing it from the decrescendo pattern characteristic of irritation. Meticulous observation of the temporal evolution of patch test reactions is paramount for accurate diagnosis and effective patient management in cheilitis.

Fulminant Perianal Donovanosis Manifesting as Septic Shock in a Treatment-Naïve AIDS Patient: A Clinico-Pathological Case Report Rahmat Firdaus Dwi Utama; Muhammad Eko Irawanto; Ayu Kusuma Dewi; Shelly Lavenia Sambodo; Stella Gracia Octarica; Sugih Primas Adjie
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.799

Donovanosis (Granuloma Inguinale), caused by Klebsiella granulomatis, is a rare sexually transmitted infection that can follow a devastating course in severely immunocompromised individuals. Its clinical progression in the context of advanced acquired immunodeficiency syndrome (AIDS) is not extensively documented. We present a case of fulminant donovanosis to illustrate its potential for rapid systemic deterioration and mortality. A 20-year-old Indonesian man, with a recent diagnosis of human immunodeficiency virus (HIV) for which he was treatment-naïve, presented with a two-month history of extensive, painful perianal ulcerations. Clinical examination revealed large, coalescing, "beefy-red" ulcers in the perianal and gluteal regions. Laboratory investigations confirmed profound immunosuppression (CD4+ T-cell count: 3 cells/µL; HIV viral load: >750,000 copies/mL). The diagnosis of donovanosis was definitively established by the microscopic identification of pathognomonic intracellular Donovan bodies on a Giemsa-stained tissue smear, with findings corroborated by histopathological analysis of a skin biopsy. Despite the initiation of appropriate antibiotic and supportive therapy, the patient's condition rapidly progressed to septic shock and multi-organ dysfunction syndrome, leading to his death within six days of hospital admission. In conclusion, this case highlights the aggressive, life-threatening nature of donovanosis in the setting of advanced AIDS. The profound collapse of cell-mediated immunity likely facilitated uncontrolled bacterial replication and systemic dissemination, rendering standard antibiotic therapy ineffective. This report serves as a critical clinical reminder to maintain a high index of suspicion for donovanosis in immunocompromised patients presenting with atypical anogenital ulcers, as early diagnosis and aggressive multimodal management are paramount.

Profile of Urticaria and Angioedema Patients at Dr. Moewardi General Hospital Surakarta, Indonesia Dewi, Ayu Kusuma; Muhammad Eko Irawanto; Stella Gracia Octarica; Shelly Lavenia Sambodo; Rahmat Firdaus Dwi Utama; Sugih Primas Adjie
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 5 (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.v8i5.994

Background: Urticaria is a heterogeneous inflammatory skin disease that results from the activation and degranulation of cutaneous mast cells, followed by the release of histamine and other mediators that cause sensory nerve activation, vasodilation, plasma extravasation, and recruitment of immune cells. The prevalence and incidence of urticaria and angioedema have been extensively studied worldwide, but there is still limited data in Indonesia, especially regarding the profile of urticaria and angioedema patients. The purpose of this study was to determine the profile of urticaria and angioedema patients at Dr. Moewardi General Hospital for the period January 1st, 2020 - December 31st, 2022. Methods: This study is a cross-sectional retrospective study with secondary data derived from medical records of urticaria and angioedema patients. Results: There were 152 patients with urticaria, most of whom were in the age group >60 years (20.39%), female with a male to female ratio of 1:1.92, and worked as housewives (17.76%) and students (16.45%). Most cases were diagnosed with urticaria (86.84%) with some patients having angioedema (13.16%). The most common comorbidities rhinoconjunctivitis (2.63%), atopic dermatitis (1.97%) and asthma (1.32%). The dominant symptoms were itching and bumps (100%). The main treatment received by patients was single AH1 (71.71%) followed by combination therapy of AH1 and systemic corticosteroids (14.47%), combination therapy of AH1 and topical corticosteroids (10.53%), and the rest received combination therapy of AH1, topical corticosteroids, and systemic corticosteroids (3.29%). The skin prick test was positive in 16 patients (35.56%), with the most common allergens found being peanut (37.5%), egg yolk (37.5%), and tomato (37.5%). Conclusion: The characteristics of urticaria patients were dominated by elderly patients, female gender, and working as housewives or not working. Patients were predominantly diagnosed with urticaria with the most common comorbidities being diabetes mellitus. The main treatment received was AH1 class drugs. The most common types of allergens identified were peanuts, egg yolks, and tomatoes.

Profile of Urticaria and Angioedema Patients at Dr. Moewardi General Hospital Surakarta, Indonesia Dewi, Ayu Kusuma; Muhammad Eko Irawanto; Stella Gracia Octarica; Shelly Lavenia Sambodo; Rahmat Firdaus Dwi Utama; Sugih Primas Adjie
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 5 (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.v8i5.994

Background: Urticaria is a heterogeneous inflammatory skin disease that results from the activation and degranulation of cutaneous mast cells, followed by the release of histamine and other mediators that cause sensory nerve activation, vasodilation, plasma extravasation, and recruitment of immune cells. The prevalence and incidence of urticaria and angioedema have been extensively studied worldwide, but there is still limited data in Indonesia, especially regarding the profile of urticaria and angioedema patients. The purpose of this study was to determine the profile of urticaria and angioedema patients at Dr. Moewardi General Hospital for the period January 1st, 2020 - December 31st, 2022. Methods: This study is a cross-sectional retrospective study with secondary data derived from medical records of urticaria and angioedema patients. Results: There were 152 patients with urticaria, most of whom were in the age group >60 years (20.39%), female with a male to female ratio of 1:1.92, and worked as housewives (17.76%) and students (16.45%). Most cases were diagnosed with urticaria (86.84%) with some patients having angioedema (13.16%). The most common comorbidities rhinoconjunctivitis (2.63%), atopic dermatitis (1.97%) and asthma (1.32%). The dominant symptoms were itching and bumps (100%). The main treatment received by patients was single AH1 (71.71%) followed by combination therapy of AH1 and systemic corticosteroids (14.47%), combination therapy of AH1 and topical corticosteroids (10.53%), and the rest received combination therapy of AH1, topical corticosteroids, and systemic corticosteroids (3.29%). The skin prick test was positive in 16 patients (35.56%), with the most common allergens found being peanut (37.5%), egg yolk (37.5%), and tomato (37.5%). Conclusion: The characteristics of urticaria patients were dominated by elderly patients, female gender, and working as housewives or not working. Patients were predominantly diagnosed with urticaria with the most common comorbidities being diabetes mellitus. The main treatment received was AH1 class drugs. The most common types of allergens identified were peanuts, egg yolks, and tomatoes.

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