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All Journal Medicinus : Jurnal Kedokteran
Mulia, Nathania Raphaeli
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Medicine & Pharmacology Public Health

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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

Abstract

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

Abstract

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.
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

Abstract

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.
Co-Authors Fatah, Abraham Kusuma, Yordan THEO AUDI YANTO, THEO AUDI