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Kadek Nova Adi Putra
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Health Professions Medicine & Pharmacology Nursing Public Health

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When Dengue and Lupus Collide: A Case Report of Overlapping Symptoms Leading to Diagnostic Delay Kadek Nova Adi Putra; I Ketut Suryana
Archives of The Medicine and Case Reports Vol. 6 No. 2 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i2.693

Abstract

Systemic lupus erythematosus (SLE) and dengue fever are two distinct diseases with overlapping clinical presentations, posing diagnostic challenges, especially in tropical regions where dengue is endemic. This case report describes a patient initially diagnosed with dengue fever who was later found to have SLE, highlighting the importance of considering SLE in the differential diagnosis of fever and thrombocytopenia even during dengue outbreaks. A 52-year-old female presented with fever, thrombocytopenia, arthralgia, myalgia, and a rash. She was initially diagnosed with dengue fever based on her clinical presentation and the prevalence of dengue in her community. However, her condition did not improve with supportive treatment, and she developed new symptoms, including shortness of breath and pleural effusion. Further investigations revealed a positive antinuclear antibody (ANA) test, leading to a revised diagnosis of SLE. The patient responded well to corticosteroid therapy and was discharged after seven days. In conclusion, this case underscores the importance of maintaining a broad differential diagnosis when evaluating patients with fever and thrombocytopenia in dengue-endemic areas. A high index of suspicion for SLE is crucial, even during dengue outbreaks, to ensure timely diagnosis and appropriate management.
When Pain Relief Turns Perilous: A Case Report on Paracetamol Dependence, Polypharmacy, and Severe Drug-Induced Liver Injury Kadek Nova Adi Putra; Bgs Gde Ariesta Darmahendra
Archives of The Medicine and Case Reports Vol. 6 No. 3 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i3.759

Abstract

Drug-induced liver injury (DILI) from long-term therapeutic paracetamol use, especially when complicated by psychological dependence, and concurrent atorvastatin therapy within a polypharmacy setting is an uncommon but serious clinical concern. This report details such a case, emphasizing the diagnostic challenges and management. A 58-year-old woman with a 20-year history of dependence on paracetamol (500-1500 mg daily) and 12 years of atorvastatin use (20 mg daily) amidst other chronic medications (levothyroxine, candesartan, clopidogrel), presented with bleeding gums, abdominal discomfort, nausea, and weakness. Laboratory investigations revealed markedly elevated liver enzymes (SGPT 3913 U/L, SGOT 5863 U/L), severe thrombocytopenia (17 x 10³/L), and elevated Gamma GT (449 U/L). Viral hepatitis markers were negative. Paracetamol and atorvastatin were discontinued. Significant clinical and biochemical improvement followed, with SGOT/SGPT levels decreasing to 184/283 U/L by day six. In conclusion, the Roussel Uclaf Causality Assessment Method (RUCAM) indicated paracetamol and atorvastatin as "probable" causes of DILI. This case underscores the potential for severe hepatotoxicity from long-term therapeutic use of common medications, especially in polypharmacy and when psychological factors influence drug consumption. Vigilant monitoring and causality assessment are crucial in such complex scenarios.
Co-Authors Bgs Gde Ariesta Darmahendra I Ketut Suryana