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Bioscientia Medicina : Journal of Biomedicine and Translational Research

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ISSN : - EISSN : 25980580 DOI : https://doi.org/10.37275/bsm

Core Subject : Health, Science,

Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

This journal welcomes the submission of articles that offering a sensible transfer of basic research to applied clinical medicine. BioScientia Medicina covers the latest developments in various fields of biomedicine with special attention to : 1.Rhemumatology 2.Molecular aspect of Indonesia Traditional Herb 3.Cardiology and Cardiovascular diseases 4.Genetics 5.Immunology 6.Environmental health 7.Toxicology 8. Neurology 9. Pharmacology 10. Oncology 11. Other multidisciplinary studies related medicine. The views of experts on current advances in nanotechnology and molecular/cell biology will be also considered for publication as long as they have a direct clinical impact on human health.

Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)

Articles 1,518 Documents

136 137 138 139 140

Selective Suppression of Prevotella and Modulation of Oral Dysbiosis in Stunted Children: The Role of Systemic Zinc as a Biological Adjuvant to Mechanical Therapy Nila Kasuma; Dewa Made Wedagama; Thifla Rafifa Wirza; Dedi Sumantri
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1514

Background: Gingivitis in stunted children represents a unique pathological entity driven by a compromised mucosal barrier and systemic zinc deficiency. These children exhibit a phenotype of acquired immunodeficiency, where standard mechanical debridement often fails to resolve inflammation, leading to a phenomenon known as dysbiotic rebound. This study investigated the biomolecular efficacy of systemic Zinc supplementation combined with scaling and root planing (SRP) in modulating the oral microbiome of nutritionally vulnerable children. Methods: A randomized, single-blind, pre-post test controlled clinical trial was conducted in Padang, Indonesia, involving 30 stunted children (Height-for-age Z-score < -2 SD) diagnosed with generalized gingivitis. Participants were randomized into a Control group (SRP + Placebo, n=15) and an Intervention group (SRP + 20mg Zinc Sulfate Monohydrate daily, n=15) for a duration of 14 days. Microbial profiling was performed on unstimulated saliva utilizing high-throughput 16S rRNA gene sequencing (V3–V4 region). Bioinformatics processing utilized the DADA2 pipeline to generate Amplicon Sequence Variants (ASVs). Results: Results indicated that SRP alone resulted in a pathogenic recolonization dominated by Firmicutes (+49.6%). Conversely, Zinc supplementation induced a significant Gram-negative crash, reducing Proteobacteria by 50.6%. Most notably, the key periodontal pathogen Prevotella was suppressed to undetectable levels in the Zinc group (p<0.05). Conclusion: Systemic zinc acts as a potent biological scaffold in the enterosalivary cycle, likely repairing the epithelial barrier and starving hemin-dependent pathogens. It is strongly recommended as a therapeutic adjuvant to prevent the ecological recurrence of gingivitis in nutritionally vulnerable pediatric populations.

Combinatorial Efficacy of Human Mesenchymal Stem Cell Secretome and Ursodeoxycholic Acid in Ameliorating Renal Dysfunction: A Synergistic Approach in a Rat Model of Cholestatic Injury Mariani Devi; Parish Budiono; Gana Adyaksa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1515

Background: Cholestatic nephropathy, historically termed cholemic nephropathy, represents a critical intersection of hepatic and renal pathology where the systemic retention of nephrotoxic cholephiles induces severe acute kidney injury. The pathophysiological cascade involves direct tubular epithelial toxicity, mitochondrial oxidative stress, and intraluminal cast formation driven by hydrophobic bile acids and bilirubin. While ursodeoxycholic acid (UDCA) serves as the standard pharmacological intervention to displace toxic bile salts, its efficacy in reversing established secondary renal injury is limited. The secretome of human mesenchymal stem cells (Hu-MSC-S) has emerged as a potent regenerative agent, rich in trophic factors capable of mitigating inflammation and promoting tissue repair. This study investigates the synergistic potential of combining standard UDCA therapy with Hu-MSC-S to preserve renal excretory function in a surgically induced model of extrahepatic cholestasis. Methods: A randomized experimental study was conducted using 24 male Wistar rats. Extrahepatic cholestasis was induced via common bile duct ligation (CBDL). Following a 2-week induction period to establish significant hepatic and secondary renal injury, rats were randomized into four groups (n=6): Control (untreated cholestasis), UDCA Monotherapy (4.5 mg/200g body weight orally), Hu-MSC-S Monotherapy (0.2 ml/kg intraperitoneally), and combination therapy (UDCA + Hu-MSC-S). Treatments were administered weekly for four weeks. Renal function was rigorously assessed through serum Urea (Urease-GLDH method) and Creatinine (Kinetic Jaffe method) levels. Results: The study demonstrated a marked renoprotective gradient across the treatment groups. The untreated Control group exhibited severe renal dysfunction with a mean Urea of 42.60 mg/dL and Creatinine of 3.18 mg/dL. Both monotherapies significantly attenuated these markers compared to controls. However, the Combination group achieved superior efficacy, restoring renal parameters to near-physiological levels (Urea: 13.08 mg/dL; Creatinine: 1.32 mg/dL). Delta analysis confirmed that the combination therapy yielded the highest magnitude of recovery for both markers. Conclusion: The concurrent administration of Hu-MSC-S and UDCA exerts a potent synergistic effect, significantly ameliorating renal dysfunction in cholestatic rats. The findings suggest that Hu-MSC-S acts as a crucial adjuvant, repairing tubular injury via paracrine mechanisms while UDCA mitigates the primary cholestatic insult, offering a novel multi-target therapeutic strategy for cholemic nephropathy.

Therapeutic Potential of Curcumin in Modulating the HMGB1/TLR4/NF-κB Axis in Polymicrobial Peritonitis: A Systematic Review and Dose-Response Meta-Analysis Leonardo Aaron Hartanto; Neni Susilaningsih; Erik Prabowo
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1516

Background: Polymicrobial peritonitis and its systemic sequela, sepsis, represent a catastrophic dysregulation of the host immune response to infection, leading to multiple organ dysfunction syndrome and high mortality rates. The pathophysiology is driven by a hyperinflammatory cytokine storm followed by immunoparalysis, governed centrally by the high mobility group box 1 (HMGB1)/toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signaling axis. Curcumin, a polyphenolic compound derived from Curcuma longa, has demonstrated potent immunomodulatory properties. However, its specific regulatory effects on this molecular axis, particularly regarding dose-dependency and novel cell death pathways like ferroptosis and lactylation, require systematic synthesis. Methods: A systematic review and meta-analysis were conducted on preclinical and clinical studies published between 2014 and 2025. Ten pivotal manuscripts meeting strict inclusion criteria were analyzed, comprising rodent models of sepsis (Cecal Ligation and Puncture, Zymosan, Lipopolysaccharide) and human clinical trials. Primary outcomes included quantitative expression levels of HMGB1, TLR4, and NF-κB, alongside organ injury scores and survival rates. Secondary outcomes analyzed downstream cytokines (TNF-α, IL-6, IL-1β) and oxidative stress markers. Data were stratified by dosage to evaluate dose-response relationships. Results: The analysis included data from 218 subjects. curcumin administration significantly attenuated the activation of the HMGB1/TLR4/NF-κB axis across all models. Quantitative analysis revealed a dose-dependent reduction in serum HMGB1 levels and a significant inhibition of NF-κB p65 nuclear translocation (p < 0.001). High-dose curcumin (100–200 mg/kg) exhibited superior efficacy in mitigating multi-organ injury compared to low-dose regimens. Novel mechanisms identified included the suppression of ferroptosis via the upregulation of the ACSL4/GPX4 axis and the inhibition of protein lactylation through p300 downregulation. Clinical data demonstrated that nano-curcumin formulations significantly reduced SOFA scores and inflammatory markers in septic patients, confirming enhanced bioavailability. Conclusion: Curcumin functions as a robust, pleiotropic inhibitor of the HMGB1/TLR4/NF-κB axis in polymicrobial peritonitis. Its therapeutic efficacy is dose-dependent and involves the regulation of emerging epigenetic and cell death pathways. These findings support the clinical integration of nano-curcumin as an adjuvant therapy for surgical sepsis.

Longitudinal Observational Analysis of Traumatic Brain Injury Epidemiology and Pre-Hospital Intervals During the COVID-19 Pandemic in a West Java Tertiary Center Ni Wayan Lisa Suasti; Akhmad Imron; Guata Naibaho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1517

Background: The COVID-19 pandemic necessitated large-scale social restrictions (PSBB) in Indonesia, drastically altering population mobility and, consequently, the landscape of neurotrauma. While the reduction in road traffic Incidents (RTIs) during lockdowns is well-documented, the collateral impact on the golden hour—the critical pre-hospital interval for traumatic brain injury (TBI) resuscitation—remains under-researched in lower-middle income countries (LMICs). This study analyzes the longitudinal shifts in TBI epidemiology, injury mechanisms, and hospital admission intervals across pre-pandemic, pandemic, and relaxation phases. Methods: This retrospective observational study analyzed 1,519 TBI patients admitted to the Emergency Department of Dr. Hasan Sadikin General Hospital (RSHS), a tertiary referral center in West Java, from January 2019 to December 2021. The cohort was stratified into three phases: Pre-Pandemic (2019), Pandemic/PSBB (2020), and Relaxation (2021). Variables included demographics, injury mechanisms, Glasgow Coma Scale (GCS), loss of consciousness (LOC), and Hospital Admission Interval (MRS). Results: Total TBI admissions exhibited a sharp V-shaped trend, decreasing by 75% in 2020 compared to 2019, driven by a collapse in RTI volume (490 to 107 cases). Admissions rebounded in 2021 (n=705). Males (78.4%) and young adults (15-24 years) constituted the majority, with RTI accounting for 74.78% of all mechanisms. While pediatric (0-4 years) and geriatric (≥65 years) groups were prone to falls, the most critical finding concerned pre-hospital delays. Despite reduced traffic density, only 3.23% of patients arrived within the golden hour (<1 hour). The majority (40.42%) arrived between 5-12 hours, and a significant cohort (17.44%) experienced delays exceeding 12 hours, indicating persistent systemic barriers to rapid care regardless of road conditions. Conclusion: The pandemic successfully suppressed TBI volume through mobility restrictions but failed to improve pre-hospital admission times. The persistence of significant delays (>5 hours) for the vast majority of patients highlights that the barriers to the golden hour in Indonesia are structural rather than traffic-dependent. Future trauma systems must address these pre-hospital inefficiencies to improve outcomes.

The Anicteric Giant: A Rare Case of Giant Choledocholithiasis and Multiple Cholelithiasis Presenting with Paradoxically Normal Bilirubin Profiles Sujek Miko Eka Putra; Mochammad Riskie Aditya Putra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1518

Background: Giant choledocholithiasis, defined as common bile duct (CBD) calculi exceeding 15 mm, typically presents with Charcot’s triad or marked biochemical cholestasis. The phenomenon of silent or anicteric giant stones remains a dangerous diagnostic blind spot. We present a rare case of a massive biliary stone burden presenting with paradoxically normal bilirubin and liver enzyme profiles, challenging standard screening algorithms. Case presentation: A 61-year-old female presented with a 12-month history of intermittent epigastric pain and nausea, initially misdiagnosed as gastritis. Despite the chronicity, she denied jaundice or fever. Biochemical analysis revealed a Total Bilirubin of 0.39 mg/dL (Reference: 0.1–1.2 mg/dL) and normal gamma-glutamyl transferase (GGT) levels, indicating an absence of biochemical obstruction. Magnetic resonance cholangiopancreatography (MRCP) identified multiple cholelithiasis and a solitary giant CBD stone. Intraoperative exploration confirmed a CBD dilated to 22 mm containing a calculus measuring 28 mm × 22 mm. Due to the massive ductal dilation and risk of recurrent stasis, the patient underwent a retrograde cholecystectomy followed by biliary reconstruction via Roux-en-Y choledochojejunostomy. Conclusion: Giant choledocholithiasis can exist in a silent phase due to ductal compliance and the ball-valve mechanism, rendering bilirubin an unreliable screening tool. This case underscores the necessity of cross-sectional imaging in chronic abdominal pain, even when biochemical markers are normal. Roux-en-Y reconstruction remains the definitive management for giant stones in significantly dilated ducts to prevent recurrence and sump syndrome.

Metabolic and Inflammatory Signatures of Neurotrauma: Correlating Early Glycemic and Leukocytic Shifts with Glasgow Coma Scale Scores Ni Wayan Lisa Suasti; Roland Sidabutar; Agung Budi Sutiono; Guata Naibaho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1519

Background: Traumatic brain injury (TBI) precipitates a profound systemic physiological stress response, often termed the sympathetic storm, characterized by neuroendocrine dysregulation and widespread inflammation. While admission biomarkers such as White Blood Cell (WBC) count and Blood Glucose levels are routinely measured, their comparative utility in stratifying injury severity—particularly in distinguishing between moderate and severe phenotypes—remains under-characterized. This study aimed to evaluate the discriminatory power of these markers, hypothesizing that metabolic and immune responses exhibit distinct saturation kinetics relative to the Glasgow Coma Scale (GCS). Methods: We conducted a retrospective analytical observational study at Dr. Hasan Sadikin General Hospital (RSHS), a level I trauma center in Bandung, Indonesia. From an annual pool of admitted neurotrauma patients (January–December 2021), a stratified sample of 238 patients aged 18-60 years was analyzed. Strict exclusion criteria were applied to minimize confounders, including a history of metabolic disease and alcohol intoxication. TBI severity was stratified into mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS 3-8). Statistical analysis utilized the Kruskal-Wallis and Mann-Whitney tests to assess non-parametric relationships. Results: The cohort was predominantly male (82.8%) and young (18-40 years, 68.9%). Both biomarkers correlated with overall severity; however, their trajectories diverged significantly. WBC counts exhibited a threshold effect, rising significantly from Mild (17.50 ± 6.56 x10³/µL) to Moderate (18.81 ± 5.27 x10³/µL) severity, but plateauing between moderate and severe groups (p>0.05), suggesting a saturation of the demargination response. Conversely, blood glucose displayed a graded linear escalation: Mild (133.11 ± 34.53 mg/dL), moderate (158.35 ± 49.59 mg/dL), and severe (226.14 ± 105.61 mg/dL) (p<0.001), with significant discrimination across all severity pairings. Conclusion: Admission hyperglycemia serves as a superior, graded biomarker for stratifying TBI severity compared to leukocytosis, which functions primarily as a binary threshold marker. The observed immune plateau contrasts with the linear metabolic scaling, highlighting stress-induced hyperglycemia as a critical indicator of severe neuro-metabolic derangement.

The Hepatotoxicity and Adherence Advantage of Short-Course Rifapentine/Isoniazid (3HP) over Stratified Isoniazid Monotherapy (6H/9H): A Systematic Review and Meta-Analysis Agus Subhan; Rohani Lasmaria
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1520

Background: The global strategy to eliminate tuberculosis hinges critically on neutralizing the latent reservoir. For decades, the standard of care has been daily Isoniazid monotherapy for 6 or 9 months. However, the effectiveness of this regimen is historically compromised by poor adherence due to its duration and significant rates of hepatotoxicity, particularly in older adults. The 3-month once-weekly regimen of Rifapentine plus Isoniazid offers a promising alternative, yet a consolidated high-level analysis comparing it specifically against stratified Isoniazid monotherapy across diverse high-risk groups was necessary to justify global policy shifts. Methods: We conducted a systematic review and meta-analysis of eight pivotal studies, including large-scale randomized controlled trials and programmatic surveillance studies. Outcomes included prevention of active tuberculosis, Grade 3/4 hepatotoxicity, and treatment completion. Data were pooled using a random effects model to account for clinical heterogeneity. Subgroup analyses stratified comparators by duration and administration method. Results: The analysis of over 10,000 participants revealed that the short-course regimen was non-inferior to isoniazid monotherapy for tuberculosis prevention (Pooled Risk Ratio 0.54; 95% CI 0.30–0.97). Crucially, the Rifapentine-based regimen demonstrated a profound reduction in grade 3/4 hepatotoxicity compared to Isoniazid monotherapy (Pooled Risk Ratio 0.16; 95% CI 0.08–0.32), with the benefit most pronounced in elderly populations. Treatment completion was significantly higher in the short-course group (Pooled Risk Ratio 1.25; 95% CI 1.15–1.36), with programmatic data confirming adherence exceeding 85% even under self-administration. Conclusion: The 3-month Rifapentine/Isoniazid regimen offers a superior safety profile and significantly higher treatment completion rates compared to Isoniazid monotherapy while maintaining equivalent efficacy. The regimen’s ability to minimize liver injury while maximizing adherence supports its adoption as a preferred standard of care, particularly for older adults.

The Uncoupling Phenomenon: Dissociation Between Albuminuria and Glomerular Filtration Rate in an Advanced Diabetic Kidney Disease Phenotype Naufal Fathi Ashari; Harnavi Harun; Russilawati; Dinda Aprilia; SM Rezvi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1521

Background: The classical paradigm of diabetic kidney disease (DKD) assumes a synchronous, linear trajectory where increasing albuminuria predicts the decline of glomerular filtration rate (GFR). However, emerging epidemiology suggests these markers may dissociate in advanced disease stages, particularly under modern renoprotective pharmacotherapy. We aimed to investigate this uncoupling phenomenon by evaluating the correlation between urine albumin creatinine ratio (UACR) and estimated GFR (eGFR) in a specific cohort of advanced DKD patients in Indonesia. Methods: We conducted a cross-sectional analytic study from January to November 2025 at Dr. M. Djamil General Hospital Padang, a tertiary referral center. The study population comprised 30 patients with established DKD, predominantly in CKD Stages 3b and 4. The primary outcome was the Spearman rank correlation (r) between UACR and eGFR, reported with 95% Confidence Intervals (CI). An exploratory sub-analysis compared trends in patients receiving SGLT2 inhibitors (n=12) versus standard care (n=18). Results: The cohort was elderly (mean age 61.93 years) with critical renal reserve depletion (median eGFR 32.50 mL/min/1.73 m²). Median UACR was 403.90 mg/g, yet exhibited massive heterogeneity (IQR: 170.82–1779.27). Spearman analysis revealed a complete lack of linear correlation between albuminuria and filtration function (r = 0.041; 95% CI: -0.322 to 0.395; p = 0.830). While SGLT2 inhibitor users (n=12) demonstrated numerically lower median UACR than non-users (n=18), the dissociation from eGFR persisted in both subgroups. Conclusion: We demonstrate a distinct dissociation between albuminuria severity and filtration function in advanced DKD. This uncoupling suggests that in late-stage nephropathy, structural glomerulosclerosis and tubulointerstitial fibrosis progress independently of permeability changes. Consequently, albuminuria cannot serve as a sole surrogate for disease progression in this phenotype, supporting a dual-biomarker strategy where UACR and eGFR are monitored as independent risk factors.

Sporadic Coexistence of Multiple Trichoepitheliomas and Solitary Neurofibroma: Mimicking Brooke–Spiegler Syndrome Rivano Frits Henry Pandaleke; Shienty Gaspersz; Ferra Olivia Mawu; Tara Sefanya Kairupan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1522

Background: The simultaneous presentation of multiple adnexal tumors and neural sheath tumors on the face typically heralds a genodermatosis, most notably Brooke–Spiegler syndrome (BSS) or neurofibromatosis type 1 (NF1). The sporadic, non-syndromic coexistence of these entities in the same anatomical region is a diagnostic pitfall that challenges the principle of parsimony. Case presentation: We report the case of a 24-year-old Asian female presenting with a 12-month history of 18 disseminated, skin-colored papules restricted to the centrofacial region, followed by the rapid development of a 3.0 cm solitary tumor on the right buccal region. Dermoscopic evaluation revealed a dichotomy in tumor morphology: the papules exhibited ivory-white backgrounds with multiple rosette signs and milia-like cysts, while the buccal tumor displayed a structureless pink pattern with absence of pigment networks. Detailed physical examination ruled out cutaneous stigmata of NF1. Histopathological analysis confirmed the diagnosis of multiple trichoepitheliomas and a solitary localized neurofibroma based on characteristic morphological features, including papillary mesenchymal bodies and mast cell presence. Immunohistochemistry was not utilized due to setting-specific resource limitations. Conclusion: This case underscores the potential for sporadic benign tumors to mimic syndromic phenotypes (phenocopies). It highlights the critical importance of recognizing key hematoxylin and eosin morphological markers and clinical signs to establish accurate diagnoses in resource-limited settings where molecular genetics and immunohistochemical staining are unavailable.

The Silent Saboteur: Chronic Refractory Erythema Nodosum Leprosum Perpetuated by Neglected Odontogenic Foci in a Post-RFT Borderline Lepromatous Patient Antonio Orson Ongkowidjojo; Luh Made Mas Rusyati; Stefanus Soewito Sutanto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1523

Background: Erythema nodosum leprosum (ENL) is a severe, immune-complex mediated complication of lepromatous leprosy that can manifest before, during, or after multidrug therapy (MDT). While the primary etiology involves the release of Mycobacterium leprae antigens, the chronicity of ENL is frequently driven by secondary, often occult, triggers. Focal infections, particularly of odontogenic origin, are frequently overlooked in standard dermatological assessments, leading to refractory clinical courses. Case presentation: We report the case of a 32-year-old male with a history of borderline lepromatous (BL) leprosy who had achieved release from treatment (RFT). The patient presented with severe, chronic, and recurrent ENL characterized by painful erythematous nodules, high-grade fever, and acute neuritis, occurring more than one year post-RFT. Laboratory evaluation revealed significant inflammatory markers, including a C-Reactive Protein level of 172.7 mg/L and leukocytosis. Crucially, intraoral examination identified neglected chronic dental caries (gangrene radix) and generalized periodontal inflammation. Despite medical advice, the patient refused dental intervention. The reactional state was managed with a combination of intravenous methylprednisolone and high-dose oral clofazimine. While cutaneous symptoms improved, the persistence of the focal infection poses a substantial risk for further recurrence. Conclusion: This case highlights the critical and often underestimated role of odontogenic focal infections as perpetuating factors in chronic ENL. It underscores the necessity for a multidisciplinary approach integrating dentistry and dermatology. We propose that recalcitrant ENL in post-RFT patients should trigger mandatory screening for occult dental infections to disrupt the cycle of systemic inflammation.

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Contact Name Rachmat Hidayat

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Editorial Address Jl. Sirna Raga no 99, 8 Ilir, Ilir Timur 3, Palembang

Location Kota palembang, Sumatera selatan INDONESIA

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Contact Name
Rachmat Hidayat

Contact Email
dr.rachmat.hidayat@gmail.com

Phone
+6281949581088

Journal Mail Official
editor.bioscmed@gmail.com

Editorial Address
Jl. Sirna Raga no 99, 8 Ilir, Ilir Timur 3, Palembang

Location
Kota palembang,

Sumatera selatan

INDONESIA