eritema nodosum necrotikan mh bl rft

8/13/2019 Eritema Nodosum Necrotikan MH BL RFT

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PRESENTED BY

A. Isra Azreani (C111 09 816)

Nor Farhana (C 111 09 870)Nur Nadia (C 111 08 776)


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Identity Name : Tn Uddin

Age : 27 years old

Adress : Kampung Beru, Kel. PAO, Kab.Jeneponto

Marital status : Married

Admission Date : 12 December 2013


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History taking

auto anamnesis

Main problem :

Wounds at the face, both hands and feet area

Systematic history taking :

Wounds at the face, both hands and feet area appearsince 2 weeks ago. At first red discoloration appear onmost part of the body after a fever and later nodulesappear and burst out became wounds. Patient feel painall over the body. History of drinking medication MDT-MB from the Puskesmas for 1 year ago (since the lastMarch of 2012). History of drugs allergy and food is

denied. History of drug intake suddenly stop is denied.


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Present status General condition

Mild disease

Conscious

Good nutritional status Good hygiene

Vital sign

Blood pressure : 120/90 mmHg

Pulse : 100 x/i

Respiratory rate: 20 x/I

Body temperature: 36.5 oc

Head

Sclera : icterus (-)

Conjunctiva : anemia(+)

Lips : cyanosis (-)

Heart/Lung

Within normal limit

AbdomenWithin normal limit

Lymph nodes

Within normal limit


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Dermatovenerology status


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Photo


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TreatmentSistemic

Methylprednisolone (3-3-0)Ofloxacin (1-0-0)

Neurodex 1x1

Topical


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ResumeA male patient, 27 years old came to the hospital withmain complaint of wounds at the face, both hands and feet

area appear since 2 weeks ago. Pain (+). At first reddiscoloration appear on most part of the body after afever(+) and later nodules appear and burst out became

wounds. History of drinking medication MDT-MB fromthe Puskesmas for 1 year ago (since the last March of2012). From the physical examination, we can found outthere is macules, hipopigmentation and erosion at the face

with the size about 2 cm. At the abdomen area, we canfound out there is macules, hipopigmentation andhiperpigmentation with the size about 1-2 cm. At boththe hands and feet, we can found out there is macules,hipopigmentation ulcus, crusta, erosion and pus with thesize about 2.5 cm.


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Theory Leprosy is a chronic infectious disease, caused by

Mycobacterium leprae is an obligate intracellular.affinity peripheral nervous as the first, then the skinand upper respiratory tract mucosa, can then to otherorgans except the central nervous system.


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Leprosy Reaction There are 2 types of leprosy reactions, namely the type

of ENL and reversal.

Leprosy reactions is the interrupt with an acuteepisode on the actual course of the disease is verychronic.

ENL mainly occur in polar lepromatous type and can

also be in the BL, means that the higher the level themore likely its multibasilar onset of ENL.


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Clinical features

PB

1-5 Lesi Hipopigmentasi/ eritema

Distribution unsimetry

Lose of sensation clearly

Only one neurologic nervewas disturbed

MB

> 5 lession Simetrical distribution

Lose of sensationunclearly

Many neurological nervewas disturbed


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Diagnosis For diagnose Leprosy according to clinical

manifestation, bacterioskopis, and histopatologis, andserologic.

Between the third, clinical diagnosis is most importantand simple. Bacteriascopic need 15-30 minutes, whilehistopatologic need 10-14 days.

Clinical finding of leprosy (+), if one of cardinal signpresent. The cardinal sign are: anestesi plaque, processthickening of neural with lose function, and BTAexamination (+).


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Diagnostic Examination In this patient, we suggest to do laboratory

examination include:

Bacterioscopic examination

Histopatologic examination

Serologic examination


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Treatment


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Prognosis Recovery from neurologic impairment is limited, but

skin lesions generally clear within the first year oftherapy. Discoloration and skin damage typicallypersist.

Physical therapy, reconstructive surgery, nerve andtendon transplants, and surgical release ofcontractures have all contributed to increasing thefunctional ability in patients with leprosy. A commonresidual deformity is insensitive feet, as seen inpersons with diabetes.

MULTIDRUG THERAPY/WHO SCHEME FOR THE TREATMENT OF LEPROSY


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MULTIDRUG THERAPY/WHO SCHEME FOR THE TREATMENT OF LEPROSY

Rifampin Clofazimine Dapsone Ofloxacin Minocycline Therapyduration

MB (>5lesions[*])

600 mg oncemonthly

300 mg oncemonthly and50 mg daily

100 mg daily 12 blisterpacks over 12to 18 months

PB (25lesions[*])

600 mg oncemonthly

100 mg daily 6 blister packsover 6 to 9months

PB (singlelesion[*])

600 mg 1 400 mg 1 100 mg 1 Single dose

Dose adjustments for children10 to 14 yearsof age, MB[]

450 mg oncemonthly

150 mg oncemonthly and50 mg everyother day

50 mg daily 12 blisterpacks over 12to 18 months


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eritema nodosum necrotikan mh bl rft

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