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All Journal Malang Respiratory Journal Deka in Medicine
Rahman, Perdana
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Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health Other

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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.
Rare Case : Lymphangioleiomyomatosis in a 28 year-old woman with spontaneous bilateral pneumothorax Matabei, Shannon Conversia Pdabo; Djajalaksana, Susanthy; Chozin, Iin; Erawati, Dini; Wardhana, Koernia; Yudhanto, Hendy; Rahman, Perdana; Chen, Chung-Yu
Malang Respiratory Journal Vol. 7 No. 2 (2025): Volume 7 No 2, September 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.02.04

Abstract

Introduction: Lymphangioleiomyomatosis (LAM) is an extremely rare disease with no known exact cause, in which there are abnormalities in the development of smooth muscle cells. This condition manifests in multiple organs, one of which is the lungs. Prevalence of LAM is 1 in 1,000,000, most commonly found in women of reproductive age. Pneumothorax occurs in two-thirds of LAM patients. It is possibly underdiagnosed in Indonesia. Case report: A 28-year-old woman came to the Emergency Department with sudden severe shortness of breath. Chest X-ray shows bilateral pneumothorax predominantly on the left side, and a chest tube was installed. Thorax MSCT revealed multiple cysts in all areas of lungs, while abdominal USG and MRI discovered masses in uterus and right adrenal. Left bullectomy-thoracotomy and lung biopsy were performed, with histopathology result supporting LAM. The patient was stable post surgery. LAM is associated with mutations in TSC1 or TSC2 genes, resulting in cystic changes caused by LAM cells proliferation in the lungs. In this patient, bilateral pneumothorax resulted from multiple subpleural cysts which eventually ruptured. Diagnosis of LAM was established by radiological imaging and lung biopsy. Surgical and non-surgical interventions were performed to address the acute manifestations of LAM. Unfortunately, Sirolimus which is the recommended long-term medication for LAM is not yet available in Indonesia. Conclusion: LAM is a rare disease. It’s important for clinicians to be familiar with this condition, aware of its progression and possible recurrence of pneumothorax, in order to provide appropriate interventions.
Co-Authors Chen, Chung-Yu Chozin, Iin Djajalaksana, Susanthy Erawati, Dini Insanfadhil, Muhammad Matabei, Shannon Conversia Pdabo Wardhana, Koernia Yudhanto, Hendy