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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Mario Korwa
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Beyond the Usual Suspects: Phialophora verrucosa Chromoblastomycosis in a Swimming Pool Attendant and Gardener Andrew Wicaksono; Ni Luh Putu Ratih Vibriyanti Karna; Mario Korwa; Nandya Dwizella; Herman Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1422

Abstract

Background: Chromoblastomycosis (CBM) is a chronic, debilitating subcutaneous mycosis caused by traumatic inoculation of dematiaceous fungi. As a Neglected Tropical Disease, it poses significant diagnostic and therapeutic challenges, particularly in the endemic tropical and subtropical regions where it is most prevalent. While Fonsecaea pedrosoi is the most common etiologic agent, infections by other species are crucial to document for accurate epidemiological surveillance. Case presentation: A 26-year-old immunocompetent male presented with a four-year history of a slowly progressive, verrucous plaque on his right hand, initiated by minor trauma. His history was notable for regular gardening without protective gear. A comprehensive diagnostic workup was performed. Dermoscopy revealed features characteristic of CBM, including reddish-black dots and yellowish-orange areas. While direct microscopy of skin scrapings was negative, histopathology of a skin biopsy confirmed a suppurative granulomatous reaction with pathognomonic muriform cells. Fungal culture on Sabouraud's dextrose agar definitively identified the causative agent as Phialophora verrucosa. The patient showed marked clinical improvement after three months of treatment with oral itraconazole (200 mg/day). Conclusion: This case highlights the successful diagnosis of a rare CBM pathogen in Indonesia through a systematic, multimodal approach. It reinforces the need for a high index of suspicion for this mycosis in patients from endemic areas with chronic verrucous lesions and a history of cutaneous trauma. The essential role of mycology culture for definitive species identification is underscored, a critical step for guiding therapy and informing public health strategies.
Gray Patch Tinea Capitis by Microsporum canis in a Child: A Case Report Highlighting Environmental Risk Factors and Diagnostic Nuances Mario Korwa; Luh Made Mas Rusyati; Handelia Phinari; Andrew Wicaksono; Nandya Dwizella
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1429

Abstract

Background: Tinea capitis, a dermatophytosis of the scalp, is a leading cause of hair loss in children. Its successful management hinges on understanding its complex etiology, including host susceptibility and pathogen virulence. Microsporum canis, a zoophilic fungus, is a primary causative agent, yet its transmission pathways and diagnostic markers are not fully elucidated. Case presentation: A 3-year-old female presented with a two-week history of progressive, pruritic alopecia. Clinical history was notable for the absence of animal contact but revealed significant environmental exposure at a hair salon. Dermatological examination showed multiple, well-demarcated, alopecic patches with fine scaling, characteristic of gray patch tinea capitis. While Wood's lamp examination was negative, trichoscopy revealed comma hairs and Morse code-like hairs, suggesting fungal infection. Microscopic examination of hair shafts confirmed an ectothrix invasion pattern, and fungal culture definitively identified Microsporum canis. The patient achieved complete resolution following a six-week course of oral griseofulvin and adjuvant topical ketoconazole. Conclusion: This case demonstrates that indirect fomite transmission from environmental reservoirs like hair salons is a critical risk factor for zoophilic tinea capitis, independent of animal contact. It further establishes trichoscopy as an essential tool for accurate, rapid diagnosis when classic signs, such as Wood's lamp fluorescence, are absent, thereby optimizing patient management and public health outcomes.
Gray Patch Tinea Capitis by Microsporum canis in a Child: A Case Report Highlighting Environmental Risk Factors and Diagnostic Nuances Mario Korwa; Luh Made Mas Rusyati; Handelia Phinari; Andrew Wicaksono; Nandya Dwizella
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1429

Abstract

Background: Tinea capitis, a dermatophytosis of the scalp, is a leading cause of hair loss in children. Its successful management hinges on understanding its complex etiology, including host susceptibility and pathogen virulence. Microsporum canis, a zoophilic fungus, is a primary causative agent, yet its transmission pathways and diagnostic markers are not fully elucidated. Case presentation: A 3-year-old female presented with a two-week history of progressive, pruritic alopecia. Clinical history was notable for the absence of animal contact but revealed significant environmental exposure at a hair salon. Dermatological examination showed multiple, well-demarcated, alopecic patches with fine scaling, characteristic of gray patch tinea capitis. While Wood's lamp examination was negative, trichoscopy revealed comma hairs and Morse code-like hairs, suggesting fungal infection. Microscopic examination of hair shafts confirmed an ectothrix invasion pattern, and fungal culture definitively identified Microsporum canis. The patient achieved complete resolution following a six-week course of oral griseofulvin and adjuvant topical ketoconazole. Conclusion: This case demonstrates that indirect fomite transmission from environmental reservoirs like hair salons is a critical risk factor for zoophilic tinea capitis, independent of animal contact. It further establishes trichoscopy as an essential tool for accurate, rapid diagnosis when classic signs, such as Wood's lamp fluorescence, are absent, thereby optimizing patient management and public health outcomes.
Beyond the Usual Suspects: Phialophora verrucosa Chromoblastomycosis in a Swimming Pool Attendant and Gardener Andrew Wicaksono; Ni Luh Putu Ratih Vibriyanti Karna; Mario Korwa; Nandya Dwizella; Herman Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1422

Abstract

Background: Chromoblastomycosis (CBM) is a chronic, debilitating subcutaneous mycosis caused by traumatic inoculation of dematiaceous fungi. As a Neglected Tropical Disease, it poses significant diagnostic and therapeutic challenges, particularly in the endemic tropical and subtropical regions where it is most prevalent. While Fonsecaea pedrosoi is the most common etiologic agent, infections by other species are crucial to document for accurate epidemiological surveillance. Case presentation: A 26-year-old immunocompetent male presented with a four-year history of a slowly progressive, verrucous plaque on his right hand, initiated by minor trauma. His history was notable for regular gardening without protective gear. A comprehensive diagnostic workup was performed. Dermoscopy revealed features characteristic of CBM, including reddish-black dots and yellowish-orange areas. While direct microscopy of skin scrapings was negative, histopathology of a skin biopsy confirmed a suppurative granulomatous reaction with pathognomonic muriform cells. Fungal culture on Sabouraud's dextrose agar definitively identified the causative agent as Phialophora verrucosa. The patient showed marked clinical improvement after three months of treatment with oral itraconazole (200 mg/day). Conclusion: This case highlights the successful diagnosis of a rare CBM pathogen in Indonesia through a systematic, multimodal approach. It reinforces the need for a high index of suspicion for this mycosis in patients from endemic areas with chronic verrucous lesions and a history of cutaneous trauma. The essential role of mycology culture for definitive species identification is underscored, a critical step for guiding therapy and informing public health strategies.
The Oral-Skin Axis in Autoinflammation: A Case Report of Severe Refractory Generalized Pustular Psoriasis (GPP) Resolved by Comprehensive Periodontal Intervention Ni Putu Wina Widyastuti; Prima Sanjiwani Saraswati Sudarsa; Herman Saputra; Handelia Phinari; Luh Putu Venny Cempaka Sari; Kevin Jonathan Djuanda; Mario Korwa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1499

Abstract

Background: Generalized pustular psoriasis (GPP) is a severe, IL-36-driven autoinflammatory dermatosis, distinct from psoriasis vulgaris. Chronic periodontitis (CP) is a dysbiotic inflammatory disease sharing pathogenic pathways (IL-1, IL-17). An "oral-skin axis" has been hypothesized, but definitive clinical evidence of CP driving a GPP flare is scarce. Case presentation: We present a 37-year-old male with a history of plaque psoriasis who developed a severe, refractory GPP flare (GPPASI 35.8) with high-grade fever (38.9°C), profound neutrophilic leukocytosis (22.5 x 10³/µL), and markedly elevated CRP (150 mg/L). The flare was resistant to maintenance methotrexate. Workup revealed severe CP with multiple periapical abscesses, culture from which grew Porphyromonas gingivalis and Fusobacterium nucleatum. The patient underwent a comprehensive dental intervention, including emergency extractions and full-mouth debridement, with concurrent peri-operative Amoxicillin-Clavulanate therapy. This combined intervention led to a rapid resolution of fever, neutrophilia, and cutaneous pustulation within 72 hours, without any escalation of systemic immunomodulators. He achieved complete remission (GPPASI 1.0) at 3-month follow-up. Conclusion: This case provides a strong temporal association supporting the oral-skin axis, highlighting severe periodontitis as a potent trigger and amplifier for GPP. The rapid resolution following a combined surgical and antibiotic intervention suggests that targeting the oral inflammatory and microbial reservoir is a critical, actionable strategy. We strongly recommend consideration of a comprehensive dental/oral screening in patients with refractory GPP.
The Oral-Skin Axis in Autoinflammation: A Case Report of Severe Refractory Generalized Pustular Psoriasis (GPP) Resolved by Comprehensive Periodontal Intervention Ni Putu Wina Widyastuti; Prima Sanjiwani Saraswati Sudarsa; Herman Saputra; Handelia Phinari; Luh Putu Venny Cempaka Sari; Kevin Jonathan Djuanda; Mario Korwa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1499

Abstract

Background: Generalized pustular psoriasis (GPP) is a severe, IL-36-driven autoinflammatory dermatosis, distinct from psoriasis vulgaris. Chronic periodontitis (CP) is a dysbiotic inflammatory disease sharing pathogenic pathways (IL-1, IL-17). An "oral-skin axis" has been hypothesized, but definitive clinical evidence of CP driving a GPP flare is scarce. Case presentation: We present a 37-year-old male with a history of plaque psoriasis who developed a severe, refractory GPP flare (GPPASI 35.8) with high-grade fever (38.9°C), profound neutrophilic leukocytosis (22.5 x 10³/µL), and markedly elevated CRP (150 mg/L). The flare was resistant to maintenance methotrexate. Workup revealed severe CP with multiple periapical abscesses, culture from which grew Porphyromonas gingivalis and Fusobacterium nucleatum. The patient underwent a comprehensive dental intervention, including emergency extractions and full-mouth debridement, with concurrent peri-operative Amoxicillin-Clavulanate therapy. This combined intervention led to a rapid resolution of fever, neutrophilia, and cutaneous pustulation within 72 hours, without any escalation of systemic immunomodulators. He achieved complete remission (GPPASI 1.0) at 3-month follow-up. Conclusion: This case provides a strong temporal association supporting the oral-skin axis, highlighting severe periodontitis as a potent trigger and amplifier for GPP. The rapid resolution following a combined surgical and antibiotic intervention suggests that targeting the oral inflammatory and microbial reservoir is a critical, actionable strategy. We strongly recommend consideration of a comprehensive dental/oral screening in patients with refractory GPP.
Therapeutic Outcomes of Secukinumab 300 mg in Severe Psoriasis Vulgaris with Metabolic Comorbidities: A Retrospective Cohort Study in Bali Prima Sanjiwani Saraswati Sudarsa; Mario Korwa; Nyoman Suryawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1552

Abstract

Background: Psoriasis vulgaris is a systemic inflammatory disease increasingly prevalent in Southeast Asia, often complicated by metabolic syndrome. While Secukinumab, an IL-17A inhibitor, is established in Western cohorts, real-world data on its efficacy in Indonesian populations with high adiposity burdens are scarce. This study evaluates the therapeutic response and safety of Secukinumab 300 mg in a Balinese cohort characterized by severe disease and metabolic risk factors. Methods: We conducted a retrospective cohort study at a tertiary referral center in Bali from January 2023 to December 2024. The study included 39 adult patients with moderate-to-severe psoriasis treated with Secukinumab 300 mg. The primary endpoint was the proportion of patients achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI 75) at Week 17. Fisher’s Exact Test was employed to analyze response differences between obese and non-obese subgroups. Results: The cohort exhibited a high systemic burden: 44.2% were obese (Body Mass Index greater than or equal to 25 kg/m2), and 53.8% had concomitant psoriatic arthritis. Baseline disease severity was high with a median body surface area of 25.0%. At week 17, 32 patients (82.1%; 95% confidence interval: 67.3–91.0%) achieved PASI 75. Subgroup analysis revealed no statistically significant difference in response rates between obese and non-obese patients (p > 0.99), suggesting efficacy is maintained despite metabolic burden. No severe adverse events or discontinuations were documented in the medical records. Conclusion: Secukinumab 300 mg demonstrates substantial efficacy in an Indonesian population with a severe phenotypic profile, maintaining therapeutic clearance in metabolically compromised patients. The safety profile appears favorable, though limited by retrospective data capture.
Therapeutic Outcomes of Secukinumab 300 mg in Severe Psoriasis Vulgaris with Metabolic Comorbidities: A Retrospective Cohort Study in Bali Prima Sanjiwani Saraswati Sudarsa; Mario Korwa; Nyoman Suryawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1552

Abstract

Background: Psoriasis vulgaris is a systemic inflammatory disease increasingly prevalent in Southeast Asia, often complicated by metabolic syndrome. While Secukinumab, an IL-17A inhibitor, is established in Western cohorts, real-world data on its efficacy in Indonesian populations with high adiposity burdens are scarce. This study evaluates the therapeutic response and safety of Secukinumab 300 mg in a Balinese cohort characterized by severe disease and metabolic risk factors. Methods: We conducted a retrospective cohort study at a tertiary referral center in Bali from January 2023 to December 2024. The study included 39 adult patients with moderate-to-severe psoriasis treated with Secukinumab 300 mg. The primary endpoint was the proportion of patients achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI 75) at Week 17. Fisher’s Exact Test was employed to analyze response differences between obese and non-obese subgroups. Results: The cohort exhibited a high systemic burden: 44.2% were obese (Body Mass Index greater than or equal to 25 kg/m2), and 53.8% had concomitant psoriatic arthritis. Baseline disease severity was high with a median body surface area of 25.0%. At week 17, 32 patients (82.1%; 95% confidence interval: 67.3–91.0%) achieved PASI 75. Subgroup analysis revealed no statistically significant difference in response rates between obese and non-obese patients (p > 0.99), suggesting efficacy is maintained despite metabolic burden. No severe adverse events or discontinuations were documented in the medical records. Conclusion: Secukinumab 300 mg demonstrates substantial efficacy in an Indonesian population with a severe phenotypic profile, maintaining therapeutic clearance in metabolically compromised patients. The safety profile appears favorable, though limited by retrospective data capture.
Co-Authors Andrew Wicaksono Handelia Phinari Herman Saputra Kevin Jonathan Djuanda Luh Made Mas Rusyati Luh Putu Venny Cempaka Sari Nandya Dwizella Ni Luh Putu Ratih Vibriyanti Karna Ni Putu Wina Widyastuti Nyoman Suryawati Prima Saraswati Sanjiwani Sudarsa