sindrom stevens-johnson case - revisi

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SINDROM STEVENS- JOHNSON Pembimbing : dr. Sri Primawati Indraswari, Sp.KK Oleh: Vanda Sativa Julianti (030.09.261) Fakultas Kedokteran Universitas Trisakti SMF Kulit dan Kelamin RSUD Kardinah Tegal, Jawa Tengah Laporan Kasus

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SINDROM STEVENS-JOHNSONSINDROM STEVENS-JOHNSONPembimbing : dr. Sri Primawati Indraswari, Sp.KKOleh: Vanda Sativa Julianti (030.09.261)a!ulta" #$d%!t$&an 'niv$&"ita" T&i"a!tiSM #ulit dan #$la(in RS'D #a&dina) T$*al+ Ja,a T$n*a)-a.%&an #a"u" -a.%&an #a"u"/END0H'-'0NSind&%( St$v$n"-J%)n"%nSind&%( 1an* ($n*$nai !ulit+ "$la.ut l$ndi& di %&i2"iu(+ dan (ata d$n*an !$adaan u(u( 3$&va&ia"i da&i &in*an "a(.ai 3$&atD$2ni"i0l$&*i %3at (4506)+ .$n1a!it graft versus host+ in7$!"i+ va!"ina"i+ n$%.la"(a+ &adia"iEti%l%*iE&it$(a+ v$"i!$l8 3ula+ .u&.u&aE&%"i+ $!"!%&ia"i+ !&u"ta#%n9un*tiviti" !ata&ali"-$"i #ulitSind&%( St$v$n"-J%)n"%n2-36 .$&-9uta .%.ula"i di E&%.a dan 0($&i!a: = ;RS C( di 3a,a) .&%C. Ii.)%id$u" d$n*an t$.i ta9a(+ !$n1al+ .$&(u!aan &ata n1$&i t$!an (H)+ li$n tida! t$&a3a ($(3$"a&P6RKUS%Shifting dullness (H)P6RKUS%Shifting dullness (H)&USKU74&S%Bi"in* u"u" (H) n%&(al&USKU74&S%Bi"in* u"u" (H) n%&(alStatu" A$n$&ali"In*uinal/$(3$"a&an #AB (-)+ (a""a (-)A$nitaliaTida! dit$(u!an adan1a !$lainan+ 9$ni" !$la(in .$&$(.uan+ &a(3ut .u3i" (H)+ tanda &adan* (-)+ "$!&$t (-)E!"t&$(ita"Si($t&i"+ tida! t$&da.at !$lainan .ada 3$ntu! tulan*+ .%"i"i tan*an dan !a!i+ "$&ta "i!a. 3adan+ tida! t$&da.at !$t$&3ata"an *$&a! "$ndi+ a!&al )an*at .ada !$$(.at $!"t&$(ita"+ "ian%"i" (-)+ pitting edema ./1 pada kedua tun!kai awah+ capillary refll time J 2 d$ti!Statu" D$&(at%l%*i!u"'niv$&"ali"Di"t&i3u"i@a9a)+ (ata+ t$lin*a+ l$)$&+ dada+ .a1uda&a+ aDilla !anan dan !i&i+ a3d%($n+ .un**un*+ *lut$al+ $!"t&$(ita" ata" !anan dan !i&i+ dan $!"t&$(ita" 3a,a) !anan dan !i&i0d &$*i%Multi.$l+ !%nGu$n"+ 3$ntu! i&$*ul$&+ 3$&3ata" t$*a"+ 3$&u!u&an .la!at+ data& d$n*an !ulit+ !$&in*-$"iMa!ula $&it$(a+ (a!ula )i.$&.i*($nta"i+ "!ua(a+ li!$ni2!a"iEG%&$"$n"iStatu" D$&(at%l%*i!u"R$*i%nalDi"t&i3u"iMu!%"a 3i3i& dan 3u!al0d &$*i%Multi.$l+ !%nGu$n"+ 3$&3$ntu! i&$*ul$&+ 3$&3ata" t$*a"+ 3$&u!u&an nu(ula&+ data& d$n*an !ulit+ !$&in*-$"iE&%"i+ !&u"ta !$)ita(anEG%&$"$n"iStatu" d$&(at%l%*i!u"Statu" d$&(at%l%*i!u"Statu" d$&(at%l%*i!u"Statu" d$&(at%l%*i!u"8ematolo!iPemeriksaan Nilai Satuan Nilai N%&(al7eukosit =.3 10008u- >.0-10.06ritrosit )9: 1.000.0008u- >.2-5.>8emo!loin ;9: *8dl 12.0-16.08ematokrit 2491 6 3=->= (O)+ $%"in%2l 1 (N)+ -ED 1 9a( 62 (O)+ -ED 2 9a( 93 (O)+ SAOT 302.3 (O)+ SA/T >39.6 (O)+ u&$u( 5? (O)+ dan anti H0V 4200. R$"u($Dia*n%"i" Dia*n%"i" #$&9aSind&%( St$v$n"-J%)n"%n $t Cau"a al$&*i %3at0n$(ia dan H$.atiti" 0/$($&i!"aan an9u&an#%n"ul ".$"iali" .$n1a!it dala( dan ".$"iali" *iFi !lini!/$($&i!"aan $l$!t&%lit/$natala!"anaan Penatalaksanaan khusus .medikamentosa)Penatalaksanaan khusus .medikamentosa)Penatalaksaan Umum Penatalaksaan Umum /EN0T0-0#S0N00N/$natala!"anaan '(u(M$n*)$nti!an "$*ala %3at 1an* di"an*!a "$3a*ai !au"an1aRa,at ina.M%nit%&in* !$adaan u(u(+ tanda vital+ dan !$"$i(3an*an Cai&anEdu!a"iM%tiva"i/$natala!"anaan #)u"u"5a-l 0+:E 2 D .$& )a&i (.a*i dan "%&$ )a&i) untu! !u(u&!l%3$ta"%n$ .&%.i%nat 0+5 (*Krim pelema E lan%lin an)id&at 60 (*+ i"%.&%.il(i&i"tat 1=0 (*+ "$tilal!%)%l 20 (*+ "%&3itan (%n%"t$a&a ?0 (*+ *li"$&%l 100 (*+ di($ti!%n 50 (*+ dan a"a( "%&3at 1.5 (* (merk E d$Cu3al !&i()T%.i!al M$til.&$dni"%l%n 2 D 62+5 (* i.vC)l%&.)$ni&a(in$ (al$at$ ta3 3 D 1 .$&-%&al&anitidin 2 D 50 (* i.vSi"t$(i! /&%*n%"i" Du3ia ad 3%na(Pu% ad vita(ad 3%na(Pu% ad 7un*"i%na(Du3ia ad (ala(Pu% ad "anti%na(ad 3%na(Pu% ad !%"($ti!u(/EMB0H0S0N0na(n$"i"/$($&i!"aan i"i!Sind&%( St$v$n"-J%)n"%nA$9ala .&%d&%(al+ &i,a1at .$(a!aian %3at "$3$lu(n1a+ TRI0S #E-0IN0NStatu" *$n$&ali" dan "tatu" d$&(at%l%*i!u"Statu" *$n$&ali" dan "tatu" d$&(at%l%*i!u"Sind&%( St$v$n"-J%)n"%n ($&u.a!an "ind&%( 1an* ($n*$nai !ulit+ "$la.ut l$ndi& di %&i2"iu(+ dan (ata /$n1$3a3 uta(a "ind&%( ini iala) al$&*i %3at+ l$3i) da&i 506: 3i"a 9u*a di"$3a3!an %l$) in7$!"i+ va!"ina"i+ .$n1a!it graftversushost+ n$%.la"(a+ dan &adia"i/at%*$n$"i"n1a (a"i) 3$lu( 9$la" ,alau.un "$&in* di)u3un*!an d$n*an &$a!"i al$&*i ti.$ III dan IV/$natala!"anaanSi"t$(i!I(un%"u.&$"i7(#%&ti!%"t$&%id) (a"i) !%nt&%v$&"ialSi(.t%(ati! T%.i!alM$(3antu t$&a.i "i"t$(i!0ntiinGa(a"i dan .$l$(3a30.a3ila !ita 3$&tinda! C$.at dan t$.at+ (a!a .&%*n%"i" Cu!u. ($(ua"!an0n*!a !$(atian .ada .a"i$n "ind&%( St$v$n"-J%)n"%n ($nCa.ai 5-1260.a3ila !ita 3$&tinda! C$.at dan t$.at+ (a!a .&%*n%"i" Cu!u. ($(ua"!an0n*!a !$(atian .ada .a"i$n "ind&%( St$v$n"-J%)n"%n ($nCa.ai 5-126/&%*n%"i" /alin* .$ntin* E $valua"i %3at !au"ati7n1a In vit&% t$"t atau .atC) t$"t t$&)ada. ($di!a"i al$&*i %3atR$"t&i!"i .a.a&an (ata)a&i untu! ($(3antu ($n*ata"i .$&u3a)an .i*($n/$nC$*a)an