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All Journal MNJ (Malang Neurology Journal) Paediatrica Indonesiana Cermin Dunia Kedokteran
Candra, Riky
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Health Professions Medicine & Pharmacology Neuroscience

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SUDDEN PROGRESSIVE LOWER LIMB WEAKNESS CAUSED BY TRANSVERSE MYELITIS, MENINGITIS, AND COMMUNICANS HYDROCEPHALUS DUE TO TUBERCULOSIS: A RARE CASE REPORT Simanjuntak, Arya Marganda; Candra, Riky; Gracia, Felicita; Maryanti, Yossi; Sucipto; Sukiandra, Riki; Juananda, Desby
MNJ (Malang Neurology Journal) Vol. 12 No. 1 (2026): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2025.012.01.17

Abstract

Background: This report presents a rare case of TB myelitis with concurrent TBM, emphasizing the importance of early detection and intervention due to its atypical symptoms and high risk of neurological disability. Objective: To report a rare case of tuberculous myelitis occurring concurrently with TBM and to highlight the importance of early recognition, appropriate imaging, and timely therapeutic intervention to improve neurological outcomes. Methods: A clinical case review was conducted involving a 32-year-old male presenting with progressive neurological deficits. Clinical evaluation, neuroimaging, cerebrospinal fluid (CSF) analysis, and treatment response were assessed. Management consisted of anti-tuberculosis therapy, corticosteroids, and intensive rehabilitation, with neurosurgical intervention deferred due to medical instability. Result: he patient initially developed chronic headache, fever, and cough, followed by worsening lower limb weakness, numbness, and urinary retention. Neurological examination revealed paraplegia with sensory level at T4. Imaging demonstrated hydrocephalus and pulmonary tuberculosis, while CSF analysis confirmed TBM. A diagnosis of TB myelitis with concurrent meningitis was established. Following initiation of anti-tuberculosis therapy (2RHZE/10RH), corticosteroids, and rehabilitation, the patient showed gradual neurological improvement despite the postponement of neurosurgical procedures. However, there are still few standardized protocols for diagnosing and treating TB myelitis, which calls for more research. Conclusion: Rapid diagnosis of TB myelitis, a treatable complication of CNS tuberculosis, can significantly improve patient outcomes, necessitating further research and development of new therapeutic approaches.
Necrotizing Pneumonia: Komplikasi Langka dari Pneumonia pada Anak yang Menggunakan Rokok Vape - Laporan Kasus: Laporan Kasus Simanjuntak, Arya Marganda; Nasution, Riza Iriani; Ridar, Elmi; Cesilia, Citra; Candra, Riky
Cermin Dunia Kedokteran Vol 53 No 03 (2026): Penyakit Dalam
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i03.1790

Abstract

Introduction: Necrotizing pneumonia (NP) is a severe complication of pneumonia characterized by lung parenchymal destruction, cavitation, and significant morbidity in children. It is commonly associated with virulent bacterial infections and inadequate response to initial antibiotic therapy. Certain risk factors, including exposure to cigarette smoke and electronic cigarettes (vaping), may influence immune defense mechanisms and contribute to disease severity. Case: A 15-year-old boy presented to the emergency room with shortness of breath, persistent fever, productive cough, and bloody sputum for 2 weeks. He had no history of TB contact but had used vape and smoke cigarettes regularly during the past year. Physical examination revealed tachypnea and rhonchi on auscultation. Chest radiography demonstratedextensive consolidation, and thoracic CT scan showed cavitary lesions consistent with necrotizing pneumonia. GeneXpert sputum testing was negative for Mycobacterium tuberculosis. The diagnosis was necrotizing pneumonia (NP). Broad-spectrum antibiotics and supportive management were administered. Discussion: Early recognition of NP in children is essential to prevent complications and prolonged hospitalization. Inhalational exposures such as vaping may compromise pulmonary defense and potentially exacerbate infectious processes.Conclusion: Necrotizing pneumonia should be suspected in children with severe pneumonia unresponsive to initial therapy. Timely diagnosis and appropriate management are critical to improving clinical outcomes. Vaping is likely to play a role in this rare complication because its chemicals can damage the pulmonary defense, making it susceptible to and potentially worsening infection. Future research and awareness towards vape health effects should be enhanced to suppress the use, especially in children.
Risk factors for bradycardia in magnetic resonance imaging and computed tomography-scan examinations of children under general sedation Cesilia, Citra; Ananda, Pratama; Shiddiq, Akbar; Febriani, Febriani; Wijaya, Dewi; Candra, Riky; Fahrizon, Ramadhanti A.; Djojosugito, Fauzia A.
Paediatrica Indonesiana Vol. 66 No. 2 (2026): March 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Children often require general sedation to obtain high-quality magnetic resonance imaging (MRI) or computed tomography (CT) images, but sedation may cause complications such as respiratory depression. Identifying risk factors for sedation-related bradycardia, an indicator of severe sedation compromise, can improve patient safety during imaging. In pediatric patients, bradycardia can arise as a downstream consequence of hypoxia, airway obstruction, or inadequate ventilation, all of which represent key mechanisms of respiratory compromise during sedation. Objective To determine factors associated with bradycardia in pediatric patients undergoing MRI or CT scans under general sedation. Methods This retrospective, observational study included 328 children (<18 years of age) sedated for MRI or CT between 2022 and 2025 at Arifin Achmad Hospital. Data on age, sex, nutritional status, American Society of Anesthesiologists (ASA) status, comorbidities, number of sedative agents, sedation duration, and imaging modality were collected. Bivariate and multivariate binary logistic regression analyses were performed to identify factors associated with bradycardia. Results Bradycardia occurred in 3.0% of cases (10/328). No cases of overt respiratory depression were identified in this study. Nutritional status was significantly associated with bradycardia in bivariate (P=0.001) and multivariate (P=0.004) analyses. Children with severe malnutrition had a markedly higher risk of developing bradycardia [adjusted odds ratio/OR 6.91; 95%CI 1.84 to 25.93). Conclusion In sedated pediatric patients undergoing MRI or CT scans, severe malnutrition was the only significant predictor of bradycardia. These findings suggest that pre-sedation nutritional status assessments may help mitigate the risk of sedation-related respiratory complications.
Co-Authors Akbar Shiddiq, Akbar Ananda, Pratama Cesilia, Citra Desby Juananda, Desby Djojosugito, Fauzia A. Fahrizon, Ramadhanti A. Febriani Gracia, Felicita Maryanti, Yossi Ridar, Elmi Riki Sukiandra Riza Iriani Nasution, Riza Iriani Simanjuntak, Arya Marganda Sucipto Wijaya, Dewi