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Sugih Primas Adjie
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Health Professions Medicine & Pharmacology

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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

Abstract

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

Abstract

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.
Co-Authors Ayu Kusuma Dewi Harijono Kariosentono Muhammad Eko Irawanto Rahmat Firdaus Dwi Utama Shelly Lavenia Sambodo Stella Gracia Octarica