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Insanfadhil, Muhammad
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Extreme thrombocytosis as a rare initial manifestation of chronic myeloid leukemia: A case report Brahmantya, Herwindo; Insanfadhil, Muhammad
Deka in Medicine Vol. 2 No. 2 (2025): August 2025
Publisher : PT. DEKA RESEARCH INSTITUTE

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69863/dim.2025.e651

Abstract

BACKGROUND: Severe thrombocytosis is a rare presentation of chronic myeloid leukemia (CML), but can be associated with rapid advancement of the disease and severe consequences. The aim of this case report is to describe the management of CML with severe thrombocytosis simulating essential thrombocythemia (ET). CASE: A 29-year-old male presented to emergency department with the symptoms of pain and swelling in left lower limb for four days. Swelling began in thigh and gradually spread to lower leg and was accompanied by pain on movement. Patient was diagnosed with CML in 2019 and on Imatinib 400 mg/day since then. Physical exam showed anemic conjunctiva, splenomegaly (Schuffner 1/8), and palpable mass of left gastrocnemius muscle. MRI revealed an intramuscular cystic mass suggestive of a lymphangioma. Laboratory results presented with severe anemia, leukocytosis, and spectacular thrombocytosis (6,143,000/µL). Bone marrow aspiration revealed elevated granulopoiesis and megakaryopoiesis, 10% myeloblasts, 5:1 myeloid-to-erythroid ratio, and positive platelet aggregation. Chronic-phase CML with transformation imitating ET was the diagnosis rendered. Treatment was with hydroxyurea, nilotinib, aspirin, intravenous fluids, and thrombocytapheresis. Two days after thrombocytapheresis, the patient complained of significant clinical improvement and was able to walk independently with minimal residual pain. CONCLUSION: CML with massive thrombocytosis is noteworthy to present specifically as it may mimic ET and carry a risk of thrombotic complications. Therapy by multimodal approach using TKI, cytoreduction, and thrombocytapheresis may be highly effective.
Chronic osteomyelitis in systemic lupus erythematosus: Diagnostic and therapeutic pitfalls Insanfadhil, Muhammad; Rahman, Perdana
Deka in Medicine Vol. 2 No. 2 (2025): August 2025
Publisher : PT. DEKA RESEARCH INSTITUTE

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69863/dim.2025.e667

Abstract

BACKGROUND: Chronic osteomyelitis is a recalcitrant and difficult-to-treat bone infection, particularly in immunocompromised individuals such as patients with Systemic Lupus Erythematosus (SLE). The coexistence of chronic osteomyelitis with SLE and malnutrition is clinically rare. This article aims to describe the diagnostic approach and conservative management of chronic osteomyelitis in a patient with SLE. CASE: A 19-year-old female presented with a two-week history of medial left knee pain, progressive swelling, and difficulty walking. The symptoms had recurred intermittently since November 2020, initially beginning with swelling and ulceration, and later developing into purulent discharge. Physical examination revealed swelling from the medial to posterior aspect of the left knee, tenderness, and reduced range of motion. Radiographic imaging demonstrated bone destruction in the proximal third of the left tibia, consistent with chronic osteomyelitis. A previous wound culture showed growth of antibiotic-sensitive bacteria. The patient was also diagnosed with SLE in remission, malnutrition (BMI <18), and an asymptomatic urinary tract infection. She was treated conservatively with oral antibiotics based on culture results, nutritional supplementation, and continued immunosuppressive therapy. Follow-up demonstrated clinical improvement without systemic infection or new local complications. CONCLUSION: Chronic osteomyelitis in malnourished patients with SLE can be successfully managed with a conservative treatment approach. Comprehensive evaluation and long-term follow-up are essential to minimize the risk of recurrence and complications.
Co-Authors Brahmantya, Herwindo Rahman, Perdana