case mh perbaikan

7/26/2019 Case MH Perbaikan

1/9


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t(e original lesions, parti4ularl# i* t(e# s(o5 no signs o* in*lammation, 4an suggest a relapse.

3iopsies are use*ul *or assessing possi"le relapses.


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Case Report

1 9 #ear7old girl 5as 4ome to -ermato7enereolog# outpatient -epartment o* -r.

M. -amil Hospital adang on eptem"er =t(2008, 5it(:

Chief Co$plaint

T(ere 5ere 5(ite pat4( 5it( de4reased o* sensation on "ot( o* (er lo5er leg sin4e


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5/9

l4er : none

1"sorption : none

Mutilation : none

Contra4ture : none

Eerosis 4utis : minimal on t(e lesion1tro*i : none

&plit s)in s$ear

14id *ast "a4illi e;amination

)e*t earlo"e : 7

Rig(t earlo"e : 7

)esion on rig(t lo5er leg : 7

)esion on le*t lo5er leg : 7

*or)ing Diagnosis

3orderline tu"er4uloid t#pe lepros# relapses.

Differential Diagnosis

3orderline tu"er4uloid t#pe lepros# 5it( late re6ersal rea4tion

&uggestion

+in "iops#

Hematolog# and "lood 4(emistr#

no4ulationM.lepraeon mouse *ootpad

+eneral Treat$ent >;plain a"out t(e disease F etiolog#, t(e 4ourse, 4ompli4ation, and transmission o* t(e

disease and possi"ilit# o* rea4tion on t(e 4ourse o* t(e disease

&"ser6ation o* t(e lesions

Prognosis

uo ad 6itam : "onam

uo ad sanam : "onam

uo ad 4osmeti4um : "onam

uo ad *un4tionam : "onam

%ollow ,p (ctober th.//0

A1 : !o resolution

P21 : tatus Duo

3istopathology e'a$ination result

>pidermis : T(ere 5as a *o4al atrop(# and mild (#per+eratosis

-ermis : T(ere 5ere *ound tu"er4le 5it( epiteloid 4ell and -atia )ang(ans 4ell around

neural and in*iltration o* lim*osit 4ells peri6as4ular, periadne+sa, perineural

and upper dermis.

Result : Mor"us Hansen Tu"er4uloid

A


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Laboratory result"

Routine "lood H" : 2,= g? 2 @ g?

)eu4o4#te : BB00 / mm A00070.000

-C : 0// tD -e4reased o*

(#po7

pigmented

ma4ule

-e4reased o*

(#po7

pigmented

ma4ule

-e4reased o*

(#po7

pigmented

ma4ule

-/ )ate re6ersal

rea4tion

)ate re6ersal

rea4tion

)ate re6ersal

rea4tion

)ate re6ersal

rea4tion

T(e/ Metil

prednisolon

;2= mg/da#

Metil

prednisolon

;20 mg/da#

Metil

prednisolon

;@ mg/da#

Metil

prednisolon

;2 mg/da#

@


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Discussion

$e reported a dou"t 4ase "et5een relapse and re6ersal rea4tion a*ter 4ompleted M-T

3 in 9 #ears old girl. nitiall# patient diagnosed as relapse o* tu"er4uloid lepros# diagnosed

"ase on anamnesis and p(#si4al e;amination. T(e diagnosis o* Mor"us Hansen in t(is patient

"ase on 4ardinal sign o* lepros# 5(i4( are: . Anesthesia. 2. T(i4+ened o* t(e ner6es on

predile4tion.


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drug7resistant "a4illi 4ould 4ause a relapse eit(er. ersistent "a4illi remain dormant in tissues

5(ere drugs do not penetrate. ro"a"l# t(e small num"er o* "a4illi remained 6ia"le a*ter

potent 4(emot(erap# is ta+en 4are o* "# t(e "od#s general immune s#stem to pre6enting

relapse o* t(e disease.

Ho5e6er, in pra4ti4e relapse is not a signi*i4ant pro"lem. t is Duoted t(at t(e relapse

rate is 5ell "elo5 ? 5it( $H&7multi drug t(erap# $H&7M-T. n a Duestion sur6e#

organi'ed "# $H&, data o"tained *rom


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. $aters MR. -istinguis(ing "et5een relapse and late re6ersal rea4tion in multi drugs

treated 3T lepros#. )epros# Re6ie5. 200F B2:2A07!. Re7treatment o* lepros# relapses. 1nnual

3rasilia -ermatolog#. 200AF 80:

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