Upload
yoery-sadewo
View
214
Download
0
Embed Size (px)
Citation preview
7/25/2019 Fde Presus
1/10
PRESENTASI KASUS
FIXED DRUG ERUPTION
Pembimbing : dr. Rudi Agung W Sp.KK
Disusun oe! :
"uri s#de$o %&'&&('&&%)
KEPANITERAAN K*INIK
I*+U PEN"AKIT KU*IT DAN KE*A+IN
FAKU*TAS KEDOKTERAN UNI,ERSITAS +U-A++ADI"A-
"OG"AKARTA
%&'
1
7/25/2019 Fde Presus
2/10
STATUS PENDERITA
I. IDENTITAS PASIEN
N#m# : N/. K
Umur : )( T#!un0enis Ke#min : Perempu#n
Pe1er2##n : Ibu Rum#! T#ngg#
A#m#3 : Wonobo/o4 Tem#nggung
S3#3us Per1#$in#n : +eni1#!
Ag#m# : Is#m
II. ANAMNESIS
Keluhan Utama : Kei3 1emer#!#n d#n +eepu!
Riwayat Penyakit Sekarang
P#sien Seor#ng $#ni3#4 d#3#ng 1e poi 1ini1 Kui3 d#n Ke#min deng#n
1eu!#n 1ui3 1emer#!#n d#n meepu! di K#1i 1#n#n d#n 1iri4 T#ng#n 1#n#n d#n 1iri4
d#n 5#d#n. P#d# bibir membeng1#1 d#n meepu!. Keu!#n dir#s#1#n se2#1 6 7 !#ri
/#ng #u. Keu!#n diser3#i deng#n r#s# p#n#s. P#sien #$##n/# 6 ) !#ri /#ng #u
p#sien s#1i3 pusing4 b#3u1 d#n pie1 1emudi#n membei ob#3 di $#rung4 2ug#
memeri1s#1#n 1e m#n3ri d#n mend#p#31#n ( m#8#m ob#3 9P#r#8e3#mo4 As#m
+een#m#3 ; =.
Riwayat Penyakit Dahulu.
Ri$#/#3 Aergi : dis#ng1#
Ri$#/#3 pen/#1i3 D+ : dis#ng1#
Ri$#/#3 -iper3ensi : dis#ng1#
Ri$#/#3 pen/#1i3 /#ng s#m# : #d# 9 Sering 1#mbu! 1#mbu!#n se3i#p
3#!unn/#=
Riwayat Penyakit Keluarga
Ri$#/#3 #ergi : dis#ng1#
Ri$#/#3 pen/#1i3 D+ : dis#ng1#
Ri$#/#3 -iper3ensi : dis#ng1#
Ri$#/#3 pen/#1i3 /#ng s#m# : dis#ng1#
2
7/25/2019 Fde Presus
3/10
Riwayat Personal Sosial
+ero1o1 : dis#ng1#
Anamanesis Sistem
Sis3em =4 Sui3 3idur 9>=4 +eng#n3u1 berebi!#n
9>=4 N/eri 1ep##. Sis3em =4 d#d# berdeb#r deb#r 9>=
Sis3em Respir#si : Ses#1 n##s 9>=4 5#3u1 9>=4 Pie1 9>=
Sis3em G#s3roin3es3in# : N/eri peru3 9>=4 Kembung 9>=4 +u#9>=4 +un3#!
9>=4 Ken3u3 9@=4 5A5 9@=.
Sis3em Urogeni3# : P#n8#r#n +i1si 3erpu3us pu3us 9>=4 Ken8ing
menged#n 1u#3 9>=.
Sis3em Reprodu1si : N/eri peru3 b#$#! 9>=
Sis3em +us1uos1ee3# : Keem#!#n #nggo3# ger#1 b#$#! 9>=4 N/eri
o3o3 9@=4 N/eri sendi 9@=.
III. PEMERIKSAAN FISIK
A. Status resens
'. ,i3# sign : Te1#n#n d#r#! : '(&B& mm-g
N#di : B( Cmeni3
Respir#si : %' C meni3
Su!u : (47
%. Ke#d##n Umum : >=4 S1er# i13eri1 9>>=4 Ree1s 8#!#/#
9@@=4 iso1or4 e/e mo?emen3 9@@=.
(. #i$ung : N##s 8uping !idung 9>>=4 deormi3#s 9>>=4 se1re3 9>>=
7. Telinga : Deormi3#s 9>>=4 se1re3 9>>=
. Mulut : 5ibir 1ering 9>>=4 si#nosis9>=4 id#! 1o3or 9>>=4 id#! sime3ris
9@@=4 id#! 3remor 9>=4 S3om#3i3is 9>=4 gusi berd#r#! 9>>=.
. %eher : ben3u1 norm#4 1een2#r 3/roid 3id#1 membes#r4 1een2#r ime
3id#1 membes#r4 n/eri 3e1#n 9>=.&. Da$a
'antung
- Inspe1si : I83us 8ordis 3#1 3eri!#3
- P#p#si : Ter#b# di SI< , ine# mid8#?i8u#ris sisi3r#4 1u#3
#ng1#3 9>=
- Per1usi : Redup1es#n 3#1 3#mp#1 3#nd# 3#nd# 1#rdiomeg#i
- Aus8u3#si : 52 I>II murni reguer4 5ising 9>=4 G#op 9>=4 +urmue
9>=.
Paru
3
7/25/2019 Fde Presus
4/10
- Inspe1si : Sime3ris4 Re3r#1si 9>=
- P#p#si : Ke3ingg##n ger#1 9>=4 Fremi3us 1#n#n 1iri s#m#
- Per1usi : Sonor diseuru! #p#ng p#ru
- Aus8u3#si : ,esi1uer 9@@=4 $!eeing 9>=4 ron1i b#s#! 9>=4 ron1i
1ering 9>=
A($omen
- Inspe1si : Abdomen 3#mp#1 d#3#r 9@=4 s8#r be1#s u1# oper#si 9>=4
penon2o#n #bnorm# 9>=.
- Aus8u3#si : 5ising usus 9@= Norm#
- Per1usi : Timp#ni 9@=4 Pe1#1 ber#i! 9>=
- P#p#si : N/eri 3e1#n 9>=.
Ekstremitas
- Superior : A1r# dingin 9>=4 =4 edem# 9>=- Inerior : A1r# dingin 9>=4 =4 edem# 9>=
). Status $ermatologis
*o1#si : 5ibir 9regio #bi#is=4 E1s3remi3#s inerior deC3r# ; sinis3r#4
E1s3remi3#s superior deC3r# ; sinis3r#4 d#n Regio T!or#C.
UKK :
T#mp#1 +#1u#4 P#38! deng#n -iperpigmen3#si4 5en3u1 bu#34 u1ur#n
numu#r4 deng#n b#3#s 3eg#s4 esi mu3ipe4 predie1si region# p#d#
E1s3remi3#s inerior deC3r# ; sinis3r#4 E1s3remi3#s superior deC3r# ;
sinis3r#4 d#n Regio T!or#C.
T#mp#1 5u#4 deng#n b#3#s 3eg#s4 esi mu3ipe4 predie1si region# p#d#
E1s3remi3#s inerior deC3r#.
I*. Pemeriksaan la(oratorium
Pemeri1s##n -#si Pemeri1s##n -#si
-emogobin '' +
7/25/2019 Fde Presus
5/10
*I. Diagnosis !an$ing
FiCed drung Erup3ion
Derm#3i3is Kon3#1 Aergi
+#s3osi3osis
-erpes *#bi#is
*II. Diagnosis
FiCed drug erup3ion
*III. Penatalaksanaan
Umum
R#$#3 in#p
Tid#1 mengg#ru1 d#n menggoso1 goso1 b#gi#n b#d#n /#ng g#3#
+en2#g# Kebersi!#n 1ui3.
+en8#ri 1emung1in#n ob#3 /#ng men/eb#b1#n erupsi 3ersebu3.
Khusus
+edi1#mes3os#
R +e3ipredisoon ' mg 9'>'>&=
R
7/25/2019 Fde Presus
6/10
TIN'AUAN PUSTAKA
I. DEFINISI
FiCed drug erup3ion #d##! erupsi #ergi ob#3 /#ngbi# beru#ng #1#n 3imbu p#d#3emp#3 /#ng s#m#.
II. Ei$emiologi
Se1i3#r '& H FDE 3er2#di p#d# #n#1 d#n de$#s#4 usi# p#ing mud# /#ng pern#!
di#por1#n #d##! B bu#n. 0um#! 1#sus ber3#mb#! deng#n mening1#3n/# usi#4 !# 3erebu3
mung1in diseb#b1#n p#2#n#n ob#3 /#ng ber3#mb#!.
III. Etilogi $an Patogenesis
5#n/#1 ob#3 /#ng di#por1#n d#p#3 men/eb#b1#n FDE. "#ng p#ing sering di#por1#n
#d##! trimethoprim sulfamethaxazole, 3e3r#si1in4 #n3ipire3i14 b#rbi3ur#3e4 d#n ob#3 #n3i
i#m#si non s3eroid.
An3ibio3i1 5#rbi3ur#3 d#n
3r#nuiier
NSAID *#in>#in
Trime3roprim
su#me3#oe
Ter3r#si1in
Penisiin
Ampisiin
Amo1sisiin
Nis3#3in
+e3ronid#oe
Griseou?in
D#pson
uinine
Deri?#3
5#rbi3ur#3
Opi#3
5enodi#epine
An3i 1on?us#n
DeC3rome3rop!#n
Asiprin
P#r#8e3#mo
Ibuproen
As#m
meen#m#3
P!en#one
P#3ogenesis FDE s#mp#i s##3 ini beum di1e3#!ui p#s3i4 didug# 1#ren# re#1si
imunoogi. 5erd#s#r1#n me1#nisme imunoogi1 /#ng 3er2#di p#d# re#1si ob#3 d#p#3 berup#
IgE medi#3ed drug erup3ion4 immune 8ompeC dependen3 drug re#83ion4 8/3o3oCi8 drug
indu8ed re#83ion d#n 8e medi#3ed re#83ion.
6
7/25/2019 Fde Presus
7/10
Penei3i#n ##n1o d11 9'JJ%= membu13i1#n b#!$# esi FDE 3er2#di pening1#3#n 1#d#r
!is3#mine d#n 1omponen /#ng s#ng#3 berm#1n# 9%&&>7& n +o*=. Ke#d##n ini didug#
seb#g#i pen/eb#b 3imbun/# re#1si eri3em#4 epu! d#n r#s# g#3#.
,is# d11 9'JB)= me#1u1#n penei3i#n un3u1 menge3#!ui se imuno1ompe3en p#d#
FDE deng#n 3e!ni1 imunopero1sid#se. Ten/#3# &>B&H se ini3r#3e p#d# FDE #d##! se
imosi3 T 9T7 d#n TB=. Teri!#3 pu# pening1#3#n se m#s3 sebes#r >'&H ser3# di3emu1#n
-*A>DR p#d# imosi3 T 9imosi3 #13i= /#ng ber#d# di dermis. Ke#d##n ini s#m# deng#n
esi !ipersen3i?i3#s 3ipe #mb#3. *imosi3 T /#ng mene3#p diesi 1ui3 berper#n d##m memori
imunoogis d#n men2e#s1#n re1urensi esi p#d# 3emp#3 /#ng s#m#. ,is# d11 2ug#
meng#3#1#n b#!$# me1#nisme imunoogi bu1#n s#3u s#3un/# pen/eb#b 1e#in#n ini4 #1#n
3e3#pi #23or gene3i1 3uru3 med#s#ri 3er2#din/# FDE. Ke#d##n ini d#p#3 dibu13i1#n deng#n
3er2#din/# 1#sus FDE d##m s#3u 1eu#rg# /#ng menun2u1#n 1es#m##n p#d# -*A 5'%.
I*. "am(aran Klinis
FDE d#p#3 3imbu d##m $#13u (& meni3 s#mp#i B 2#m se3e#! inges3i ob#3 se8#r or#.
*esi berup# m#1u# o?# #3#u bu#34 ber$#rn# mer! #3#u 1eungu#n4 berb#3#s 3eg#s4 seiring
deng#n $#13u esi bis# men2#di bu#4 meng##mi des1u#m#si #3#u men2#di 1rus3#. U1ur#n esi
ber?#ri#si mu#i d#ri en3i1uer s#mp#i p#1#3. *esi #$# bi#s#n/# soi3er4 3#pi 2i1# penderi3#meminum ob#3 /#ng s#m# m#1# esi /#ng #m# #1#n 3imbu 1emb#i diser3#i deng#n esi /#ng
b#ru. N#mun 2um#! esi bi#s#n/# sedi1i3. Timbun/# 1emb#i esi di3emp#3 /#ng s#m#
men2e#s1#n #r3i 1#3# FiCedL p#d# n#m# pen/#1i3 3ersebu3.
*esi d#p#3 di2ump#i di1ui3 d#n membr#n mu1os# /#i3u di bibir4 b#d#n4 3ung1#i4
3#ng#n d#n geni3#. Temp#3 p#ing sering #d##! bibir d#n geni3#. *esi FDE p#d# penis
sering dis#ng1# seb#g#i pen/#1i3 1e#min.
Ge2## o1# meipu3i g#3# d#n r#s# 3erb#1#r4 2#r#ng di2ump#i ge2## sis3emi1. Tid#1
di2ump#i pembes#r#n 1een2#r ge3#! bening region#. *esi p#d# FDE 2i1#men/embu! #1#n
meningg#1#n ber8#1 !iperpigmen3#si pos3 in#m#si /#ng mene3#p d##m 2#ng1# $#13u
#m#.
*. #istoatologi
7
7/25/2019 Fde Presus
8/10
G#mb#r#n !is3oogi FDE men/erup#i eri3em# mu3iorme 9E+=. Seper3i p#d# E+
re#1si d#p#3 3er2#di di dermis #3#u epidermis #3#u 1edu#n/#. T#ng p#ing sering #d##! /#ng
meib#31#n dermis d#n epidermis.
P#d# 3#!#p #$# pemeri1s##n !is3op#3oogi mengg#mb#r1#n #d#n/# bu#
sebepiderm# deng#n degener#si !idropi1 se b#s# epidermis. D#p#3 2ug# di2ump#i
dis1ero3#sis 1er#3osi3 deng#n si3op#sm# eosinoii1 d#n in3i /#ng pi1no3i1 di epidermis.
P#d# 3#!#p #n2u3 d#p#3 dii!#3 me#nin d#n m#1ro#g p#d# dermis b#gi#n #3#s d#n
3erd#p#3 pening1#3#n 2um#! me#nin p#d# #pis#n b#s# epidermis.
*I. Diagnosis
Di#gnosis di3eg#s1#n berd#s#r1#n #n#mnesis d#n g#mb#r#n 1inis /#ng 1!#s. Ri$#/#3
per2##n#n pen/#1i3 /#ng rin8i4 3erm#su1 po# ge2## 1inis4 m#8#m ob#34 dosis4 $#13u d#n
#m# p#2#n#n ser3# ri$#/#3 #ergi ob#3 sebeumn/# pen3ing un3u1 membu#3 di#gnosis. Se#in
i3u pemri1s###n #bor#3orium d#p#3 di#1u1#n un3u1 menun2#ng di#gnosis.
'. 5iopsi 1ui3 memb#3u un3u1 mem#s3i1#n di#ngnosis #3#u men/ing1ir1#n d#i#ngnosis
b#nding.
%. U2i 3empe ob#3 merup#1#n prosedur /#ng 3id#1 berb#!#/#. Re#1si #n#i#1sis s#ng#3
2#r#ng 3er2#di d#n un3u1 meng#n3isip#sin/# di#n2ur1#n meng#m#3i penderri3# d##m
$#13u se3eng#! 2#m se3e#! penempe#n. Se8#r# 3eori3is d#p#3 3er2#di sensi3is#si
#1ib#3 u2i 3empe4 n#mun d##m pr#13e1n/# 2#r#ng di3emui. Tid#1 di#n2ur1#n
me#1u1#n u2i 3empe se#m# erupsi m#si! #13i m#upun seger# sesud#!n/#.
5erd#s#r1#n peng##m#n p#r# penei3i4 u2i 3empe seb#i1n/# di#1u1#n se1ur#ng
1ur#ngn/# minggu se3e#! erupsi mered#.
-#si u2i 3empe /#ng neg#3i 3id#1 me/ing1ir1#n di#gnosis erupsi ob#3 d#n !#si /#ng
posi3i d#p#3 men/o1ong di#gnosis d#n menen3u1#n pen/eb#b mes1ipun per#n/#m#si! 1on3ro?ersi. +e3ode u2i 3empe m#si! memeru1#n b#n/#1 perb#i1##n4
di#n3#r#n/# deng#n menggi#31#n penei3i#n 3en3#ng 1onsen3r#si /#ng sesu#i un3u1
se3i#p ob#34 ?e!i1uum /#ng 3ep#3 d#n menen3u1#n me3#boisme ob#3 di 1ui3.
(. U2i pro?o1#si or# merup#1#n pemeri1s##n b#1u em#s un3u1 mem#s3i1#n pen/eb#b.
U2i ini di1#3#1#n #m#n d#n d#p#3 diper8#/# un3u1 p#sien #n#1. U2i ini ber3u2u#n
un3u1 men8e3us1#n 3#nd# d#n ge2## 1inis /#ng ebi! ring#n deng#n pemberi#n ob#3
dosis 1e8i bi#s#n/# dosis ''& d#ri ob#3 pene/eb#b sud#! 8u1up un3u1
mempro?o1#si re#1si d#n pro?o1#si bi#s#n/# sud#! mun8u d##m beber#p# 2#m.
8
7/25/2019 Fde Presus
9/10
K#ren# resi1o /#ng mung1in di3imbu1#nn/# m#1# u2i ini !#rus di#1u1#n dib#$#!
peng$#s#n pe3ug#s medis /#ng 3er#3i!.
*II. Diagnosis !an$ing
'. +#s3osi3osis : 5i#s#n/# 3imbu ur3i1#ri# diser3#i 3#nd# d#rier.
%. -erpes #bi#is #3#u !erpes geni3#is : bi#s#n/# ber#ngsung ebi! 8ep#3 d#n 3id#1
meningg#1#n ber8#1 !iperpigmen3#si.
(. Derm#3i3is Kon3#1 Aergi : #d#n/# ri$#/#3 1on3#1
*III. Penatalaksanaan
'. -en3i1#n pengun##n ob#3 /#ng didug# seb#g#i pen/eb#b
%. Pengob#3#n sis3emi1
Kortikosteroi$
Pemberi#n 1or31os3eroid sis3emi1 !ingg# s##3 ini m#si! 1on3ro?ersi#4 3e3#pi
peng##m#n di FKUI di dep#r3emen imu 1ui3 d#n 1e#min un3u1 1#sus FDE ber#3memberi1#n respons s#ng#3 b#i1 d#n #ng1# mor3#i3#s menurun. P#d# FDE ring#n
diberi1#n dosis &4 mgKg55!#ri4 sed#ng1#n p#d# FDE ber#3 '>7 mg1gbb!#ri.
Antihistamin
An3i!is3#min 3e3ru3#m# diberi1#n p#d# FDE deng#n ge2## /#ng ber#3. D#p#3
diberi1#n seb#g#i 3er#pi sim3om#3is /#ng diser3#i r#s# g#3# /#ng ber#34 bi#s#n/#
dingun#1#n #n3i!is3#min gener#si per3#m# /#ng mempun/#i ee1 sed#si un3u1
1eu!#n g#3# m##m !#ri /#ng 1#d#ng mengg#nggu is3ir#!#3 p#sien.
(. Pengob#3#n 3opi1#
Pengob#3#n 3opi1# berg#n3ung p#d# 1e#d##n 1e#in#n 1ui3 #p#1#! 1ering #3#u b#s#!.
#. 0i1# esi b#s#! d#p#3 diberi1#n 1ompres se8#r# 3erbu1#. Tu2u#nn/# d##!
un3u1 mengering1#n se1sud#34 membersi!1#n debris d#n 1rus3# ser3#
memberi1# ee1 men/e2u1#n. Pengompres#n di#1u1#n 8u1up %>( 1#i se!#ri4
bi#r1#n b#s#! 93e3#pi 3id#1 s#mp#i mene3es= se#m# 6 '>(& meni3. E1sud#3
#1#n i1u3 mengering bers#m# pengu#p#n. 5i#s#n/# pengompres#n di#1u1#n
!#n/# % s#m#p#i ( !#ri s#2#.
7/25/2019 Fde Presus
10/10
%= Gun#1#n ?e!i1uum /#ng 3ep#3 sesu#i 1ondisi 1e#in#n 1ui34
mis#n/# s##p un3u1 esi 1ering d#n 3eb# ser3# 1rim un3u1 r#d#ng
ring#n #3#u ip#3#n
(= Api1#si % 1#i se!#ri se#m# )>'7 !#ri bi#s#n/# 8u1up
7= -#3i>!#3i deng#n penggun##n 1or3i1os3eroid po3ensi sed#ng seb#n/#1
M'gminggu.
= Pengun##n did#er#! /#ng o1usi !#rus !#3i>!#3i4 mis#n/# d#er#!
popo1 #3#u #Ci#.
I0. Prognosis
Prognosis umumn/# b#i1. Ap#bi# ob#3 3ers#ng1# pen/eb#n/# 3##! d#p#3 dip#s3i1#n
m#1# seb#i1n/# 1ep#d# penderi3# diberi1#n 8#3#3#n4 b#rup# 1#r3u 1e8i /#ng memu#3 2enis
ob#3 3ersebu3 ser3# goong#n/#. K#ru 3ersebu3 d#p#3 di3un2u1#n bi#m#n# diperu1#n4 se!ingg#
d#p#3 di8eg#! p#2#n#n u#ng /#ng memung1in1#n 3eru#ngn/# FDE.
10