EM, PSEUDOMEMBRAN CANDIDIASIS AND ULCER IN AIDS CONDITIONBAldy Novrizal

0906554390

Patient’s data

Medical Record : 389-14-38Place : 7th Floor RSCMDate of 1st visit : November 27 th 2013

Routine DataName : Mr. A.MSex : MaleAge : 43 years old

Anamnesis

Suffering HIV since

2010

Treatment ARV at Cibinong

hospital

Few days use ARV drugs

fever & dypsnea stop drugs

diagnosed suffer an Sanprima

allergy

Reffered to RSCM

continue starting allergy

reaction

Anamnesis

visited to POKDISUS( 1 week before hospitalized)

dypsnea, cough with sputum, fever, nausea

swelling on the eyes and vesicle

on the skindiagnosed the

patient has allergy

because the use of

neurapin, not becausecotrim

oxacole

Stop Neurapin

Anamnesis

DM since 3 years

No Hypertention and Asthma

TB (negatif)

Alcohol, Premiscuitas

refused

Was a victims sexual

abusement in 2009

Problem List

Allergic Drug Reaction type EM AIDS but not yet treated with ARV Sepsis e.c HCAP dd lungs TB DM type 2 RBBB Hordeolum Sinistra

AnamnesisPatient was reffered to be treated together with WD/ Allergic drugs reaction.

Multiple ulcers on the tongue and lips

Wound on the mouth since 1 months ago, which preceeded with wound on the skin

Painful mouth

Used drugs: Betadine gargle 4x/day, Nystatin 4x/day 1cc diluted, vaselin for lips

Extra Oral Examination

Lymph Gland Right Submandibula

Left Submandibula -

Submental -

Right Cervical -

Left Cervical -

Lips Ulcer and crustae yellow on the upper and bellow

Face -

Circum Oral -

Others -

Extra Oral Photos

Intra Oral Examination (nov 27th ‘13)

Intra Oral Examination (nov 27th ‘13)

Laboratory Test

LED 70 mm/jam Basofil 0,24 %

Hb 11,6 gr% Eosinofil 0,1 %

Ht 33,5 % Batang 80,6 %

Eritrosit 3,85 juta/mm3 Segmen 80,6 %

MCV 87 Um Limfosit 10,9 %

MCH 30,1 Pg Monosit 8,2 %

MCHC 34,6 G/dl Blast 70 %

Trombosit 409/mm3 CD 4 28 cell/μl

Retikulosit SGOT 20

Leukosit 10,16/mm3 SGPT 29

Diagnosis

Suspect Manifestation Oral EM Pseudomembran candidiasis oral Non specific ulcer related with

immunocompromised

Treatment Plan (in nov 27th ‘13)Nystatin replaced by:R/ Fluxonazole 150 mg no VS 1 dd 1treatment for lips :

Compress on lips with minocep and sterile gauze (10 minute 3x/day)Topical medicine :R/ Amox 500 mg

Prednison 5 mgAvil 25 mgVaselin lanolin 30 g

m.f ungS oles Bibir 3x/ hari

Treatment for ulcer: garg minocep gargle 3x/day

Control (in nov 29th ‘13)-Pseudomembran candidiasis healing - Krusta di bibir kering- Terlihat Ulser di vental lidah

- Flukonazole stop lanjut nystatin 4x/hr

- diberikan resep:

R/ Minosep gargle fl No IS 1 dd 10 cc

R/ Doxycyclin 100 mg no XIIS 3 dd 1 kumur buang

R/ Cinolon oint tube no IS 3 dd 1

Control

On des 2nd:- mothwash 1x/day- mouth still painfull and hard to swallow- Obat Racikan not yet available- ulcer healing on ventral and dorsum of the tongue- krusta healing on anterior lips

Erythema Multiforme- Occasionally

triggered byherpetic infection/drugs

- Affect to adolescents or young adult

- Mild fever and systemic upset may be associated

- Lips frequently swollen, crusted and bleeding

- Cutaneous lesion may consist of widespread erythema alone

- Attacks may recur at interval of several months

MANAGEMENT- Patient should be warned of possibility of recurrences-

Systemiccorticosteriod (symptomatic relief)

- Antibiotic usually given in severe case

Pseudomembran Candidiasis Oral/Thrush

- Acute Candidiosis- Common in HIV infection and

indicates low immunity- Creamy soft patches, readily

wiped off the mucosa- Smear shows many gram-

positive hyphae- Respond to antifungal or

itraconazole- Predisposing Factor:

Immunodeficiency (ex: Diabetes melitus and AIDS)

Thank You