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A Case of Neuropsychiatric Systemic Lupus Erythematosus as A Sequela of Kikuchi’s Disease Yanto, Theo Audi; Mulia, Nathania Raphaeli; Fatah, Abraham
Medicinus Vol 12, No 1 (2022): October
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v10i2.7024

The aetiology of Kikuchi’s Disease (KD), a benign condition associated with multiple lymph node enlargements, remains unknown but several reported cases associate it with systemic lupus erythematosus (SLE). A 34-year-old Indonesian woman presented with multiple painless lymph node enlargements around the neck with three weeks of fever, myalgia, arthralgia, night sweats, and weight loss. Laboratory examination showed pancytopenia and elevated ESR. HIV and tuberculin skin testing were negative. Lymph node biopsy confirmed the diagnosis of KD. One week later, despite improvement in lymphadenopathy, she developed fever. Her ANA, anti-Smith antibodies, and anti-Ribosomal-P protein antibodies were positive. She was diagnosed with SLE and managed as an inpatient with high dose methylprednisolone. One week later, the patient developed psychotic symptoms and fever. The results of Laboratory examinations with lumbar puncture were unremarkable. She was diagnosed with neuropsychiatric SLE (NPSLE) and managed with methylprednisolone, paracetamol, folic acid, alprazolam, and amitriptyline. One month later, the patient returned with three days of fever and dyspnea. Despite improvement in neuropsychiatric symptoms, pneumonia and tonsillopharyngitis were diagnosed based on physical examination and chest X- rays. Her condition deteriorated into septic shock. She suffered cardiac arrest and was pronounced dead, despite attempted resuscitation.While KD is a benign condition, diagnosis is challenging due to its rarity and similarity to other lymphadenopathy diseases. Its association with SLE and NPSLE carries poor prognosis with higher mortality rate from the disease progression and adverse medication effects. Thus, early intervention and prevention of complications are crucial in managing patientswith KD.

The Palliative Role of Colchicine on Advanced Hilar Cholangiocarcinoma Patient with Socio-Economic Challenges: A Case Report Yanto, Theo Audi; Mulia, Nathania Raphaeli; Kusuma, Yordan
Medicinus Vol. 14 No. 2 (2025): February
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v14i2.9556

Cholangiocarcinoma is a rare, slow-growing tumor that commonly presents beyond the point of resectability. Current guidelines recommend chemotherapy and radiotherapy for inoperable cases. However, palliative resources are not always accessible for patients with socio-economic barriers. Meanwhile, colchicine is a cost-effective drug and possesses anticancer effects. Here, we present a 53-year-old man with a 6-month history of painless jaundice, severe pruritus, recurrent fever, progressively growing abdominal mass, loss of appetite, and significant weight loss. He was incapable to perform adequate self-care and remained bedridden. Courvoisier sign was noted. Liver function tests show hyperbilirubinemia with elevated CA 19-9 level. Abdominal MRI 3T and MRCP showed hilar cholangiocarcinoma and obliteration of the hepatic vein. The patient and his family did not have health insurance and lived on a minimum income. Considered inoperable, the patient received daily colchicine 1 mg. Within four months, his symptoms have subsided, and he could perform several house chores. Bilirubin also showed a decreasing trend. In neoplastic cells, colchicine inhibits cell mitosis by perturbing tubulin formation. Being widely available, colchicine can be a palliative drug for terminally ill patients with socio-economic challenges. Although it improves patient performance status, we recommend further studies and close monitoring for the use of colchicine in advanced cholangiocarcinoma cases.

Pityriasis Lichenoides et Varioliformis Acuta in Adult Woman with Asymptomatic Bacteriuria: Another Possible Trigger? Yanto, Theo Audi; Mulia, Nathania Raphaeli; Fatah, Abraham; Jayadi, Nana Novia
Majalah Kedokteran Indonesia Vol 73 No 1 (2023): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.73.1-2023-642

Introduction: Pityriasis Lichenoides et Varioliformis Acute (PLEVA) is a rare and benign inflammatory skin disease. This acute form is distinguished from the milder chronic condition, Pityriasis Lichenoides Chronica (PLC). The etiology of PLEVA itself remains unclear, although it has been associated with infection as a trigger.Case: Here, we present the case of a 34-year-old woman who presented with abrupt, generalized, pruritic skin eruptions for two months.Case Discussion: The eruptions started as red scaly papules and vesicles and resolved as hyperpigmentations. She denied having any previous dermatological diseases, routine medications, or vaccinations. On examination, she showed generalized multiple hyperpigmented macules, scaly papules, and vesicles over the trunk, extremities, and face, with erosions and crusts in several areas. Eosinophilia and asymptomatic bacteria were found in her urinalysis. A skin biopsy showed diffuse lymphocytic infiltration in the dermal/epidermal junction and perivascular region, with parakeratosis and lymphocyte exocytosis. While the pathogenesis of PLEVA itself remains unclear, a triggering factor of inflammatory reaction, such as infection, may contribute to the development of the disease.Conclusion: Asymptomatic bacteriuria is associated with inflammatory responses, and thus, it can be one of many possibilities. More studies are needed to confirm this association with PLEVA. Due to the lack of a clear pathogenesis and the benign nature of the disease, this rare entity may present difficulties in diagnosis and therapy

A Case of Neuropsychiatric Systemic Lupus Erythematosus as A Sequela of Kikuchi’s Disease Yanto, Theo Audi; Mulia, Nathania Raphaeli; Fatah, Abraham
Medicinus Vol. 12 No. 1 (2022): October
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v10i2.7024

The aetiology of Kikuchi’s Disease (KD), a benign condition associated with multiple lymph node enlargements, remains unknown but several reported cases associate it with systemic lupus erythematosus (SLE). A 34-year-old Indonesian woman presented with multiple painless lymph node enlargements around the neck with three weeks of fever, myalgia, arthralgia, night sweats, and weight loss. Laboratory examination showed pancytopenia and elevated ESR. HIV and tuberculin skin testing were negative. Lymph node biopsy confirmed the diagnosis of KD. One week later, despite improvement in lymphadenopathy, she developed fever. Her ANA, anti-Smith antibodies, and anti-Ribosomal-P protein antibodies were positive. She was diagnosed with SLE and managed as an inpatient with high dose methylprednisolone. One week later, the patient developed psychotic symptoms and fever. The results of Laboratory examinations with lumbar puncture were unremarkable. She was diagnosed with neuropsychiatric SLE (NPSLE) and managed with methylprednisolone, paracetamol, folic acid, alprazolam, and amitriptyline. One month later, the patient returned with three days of fever and dyspnea. Despite improvement in neuropsychiatric symptoms, pneumonia and tonsillopharyngitis were diagnosed based on physical examination and chest X- rays. Her condition deteriorated into septic shock. She suffered cardiac arrest and was pronounced dead, despite attempted resuscitation.While KD is a benign condition, diagnosis is challenging due to its rarity and similarity to other lymphadenopathy diseases. Its association with SLE and NPSLE carries poor prognosis with higher mortality rate from the disease progression and adverse medication effects. Thus, early intervention and prevention of complications are crucial in managing patientswith KD.

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