Endang Sutedja

Disfiguring Generalized Verrucosis in an Indonesian Man With Idiopathic CD4 Lymphopenia

BACKGROUND Human papillomavirus (HPV) infections cause a spectrum of clinical disease states, depending on the causative HPV and the characteristics of the infected host, especially the status of cell-mediated immunity. Generalized verrucosis is an unusual clinical presentation of a disseminated HPV infection associated with severe immunodeficiency status. OBSERVATIONS We present a case of extreme disfigurement associated with an HPV-2 (common wart virus) infection. Virologic studies, immune status of the patient, and treatment(s) are summarized. CONCLUSIONS The severe disfigurement of this patient was a result of an underlying severe immunodeficiency, permissive for a disseminated HPV-2 infection that was allowed to progress for many years before the initiation of therapy. Such a rare case illustrates the natural history of generalized verrucosis in the setting of severe immunodeficiency in the absence of sustained medical interventions. Medical and surgical treatments resulted in marked improvement in the general health of this patient, as well as improvement of the disfigurement that resulted from the generalized verrucosis.

Stevens-Johnson syndrome and toxic epidermal necrolysis in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from 2009-2013

Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) with high mortality and have a significant public health impact because of high mortality and morbidity. Objective To describe data the epidemiological features, etiology, and treatment of retrospectively reviewed data of all patients with SJS and TEN. Methods Retrospective study was conducted in patients with SJS and TEN treated from January 1, 2009 to December 31, 2013 in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. Results A total of 57 patients were enrolled in the study. Thirty-nine cases of SJS (21 males and 18 females), 7 cases of SJS overlapping TEN (4 males and 3 females), and 11 cases of TEN (5 males and 6 females) were reported. All cases of SJS and TEN were caused by drugs, such as paracetamol (16.56%), carbamazepine (7%), amoxicillin (5.73%), ibuprofen (4.46%), rifampicin (3.18%), and trihexyphenidyl (3.18%). All cases were treated systemically with corticosteroid alone (100%). Seven from 57 patients (12,28%) died; 5 cases developed sepsis and 2 cases developed respiratory failure. The mortality rate was 7.69% in SJS, 0% in SJS/TEN overlap, and 36.36% in TEN. Conclusion The role of systemic corticosteroids in SJS and TEN are still controversial, but with a prompt and earlier treatment reduces mortality and improves outcomes of SJS and TEN patients.

RANCANGAN PRIMER SPESIFIK GEN MACROPHAGE MANNOSE RECEPTOR (MMR) UNTUK POLYMERASE CHAIN REACTION (PCR) DAN SEKUENSING DEOXYRIBO NUCLEIC ACID (DNA)

The order (sequencing) determinationof DeoxyribonucleicAcid (DNA) bases is the gene’s most basic information, using the method of Polymerase Chain Reaction (PCR) as its stage. A key factor of successful detection by PCR is specific PCR primer design choice. The detection of diversity of Mycobacterium Mannose Receptor (MMR) gene, responsible for recognizing mannosylated antigen structure of Mycobacterium tuberculosis (M.tb) by DNA sequencing of exon 7 chromosome 10p12, related to susceptiblity for Pulmonary Tuberculosis(TB), was first performed in China in 2012. The purpose of this study was to find specific primerfromboth design originated from the research in China/primer I and my own design/primer IIby using Primer3 software. This study was based on 10 healthy subjects and was a preliminary study of a research titled. The Relationship of Single Nucleotide Polymorphisms (SNPs) of Macrophage Mannose Receptor Gene to Pulmonary Tuberculosis Cases. The examination materials consist of 3 mL of EDTA blood and DNA extraction from its buffy coat. The resulting DNA was processed by PCR to amplify MMR gene with primer I and II. The primer I successfully amplified DNA fragments up to 780bp while primer II only 329 bp. The MMR gene DNA sequencing analysis was performed on the amplification result of both kinds primers by using DNA Baser and Ensembl−BLAST software. The results were different, DNA sequencing result by using the primer I was found in several chromosomes and also in several loci. Whereas, by using the primer II, it was only found in chromosome 10 and in the same locus. Based on this study, it can be concluded that the specific primer design is one of the most important factors in the success of DNA sequencing.

Systemic contact dermatitis due to corrosion of titanium-coated nickel and cobalt bone plate fixation: A case report

Rationale: Corrosion refers to the degradation of a material that occurs following its interaction with other substances in the environment. Corrosion of metallic substances into tissues may lead to inflammatory responses such as systemic contact dermatitis (SCD), a skin condition where an individual who has previously been sensitized to a particular allergen via the cutaneous route will subsequently react to same allergen via the systemic route. This condition occurs following exposure to allergens such as metals, medications, and certain food substances. In recent years, the use of metal plates for internal fixation has become increasingly common in bone fracture repairs. Patient concerns: A 34-year-old Indonesian male presented with systemic erythema with itching 7 days following a bone plate fixation as a management for mandibular fracture. Diagnoses: Physical examination showed pruritic red macules, papules, and scales on almost his entire body, along with facial swelling. The patch test results revealed a positive reaction to nickel and cobalt. Therefore, the patient was diagnosed with SCD. Interventions: The patient was treated with topical and systemic corticosteroids as well as bone plate removal. Outcome: After treatment, the eruption turned brown, the itching was resolved, and there were no facial swelling as well. Lessons: This case report highlights the need to consider the occurrence of SCD in patients following bone plate fixation.

Coconut Shell Liquid Smoke Promotes Burn Wound Healing

The aim of this study was to evaluate burn wound healing activity of coconut shell liquid smoke (CS-LS) in a burn wound animal model. Burn wound–induced mice were treated with CS-LS (CS-LS group), povidone iodine 10% (povidone group), or NaCl 0.9% (NaCl group). Application of CS-LS promoted wound contraction compared to that of the povidone and NaCl groups (P < .05). This study showed a positive correlation between the number of fibroblasts and wound contraction. The number of fibroblasts was highest in the CS-LS group, compared to that of the povidone and NaCl groups (P < .05). In conclusion, CS-LS promotes burn wound healing by one possible mechanism, by increasing the number of fibroblasts. The results indicate that further experimental trials are needed to develop CS-LS as an alternative topical drug for burn wound healing.

The Rare Case of Pemphigus Vegetans in Association with Malnutrition Children in the Multidisciplinary Management

Pemphigus vegetans is a clinical variant of pemphigus vulgaris, accounting for 1–2% of all very rare pemphigus cases in children. The involvement of the oral mucosa in this disease is usually accompanied by severe pain that aggravates the patient’s malnourished condition. Conversely, malnutrition may also reduce vulnerability towards autoimmune diseases. Although pemphigus vegetans has never been reported to develop in a child with marasmus before, we encountered a case of pemphigus vegetans in a severely malnourished patient. A 12-year-old boy in marasmic condition presented with painful, clear, fluid-filled blisters, accompanied by erosions, crusts, and vegetative lesions on almost all parts of the body. Histopathological examination of the lesions revealed a suprabasal cleft, and direct immunofluorescence staining showed deposits of immunoglobulin G in the epidermal intracellular spaces. The patient was treated with a multidisciplinary approach, and intravenous corticosteroid was administered for 2 weeks with an appropriate diet. There were significant improvements in the skin lesions and his nutritional status. Although pemphigus vegetans may occur in children with malnutrition, the underlying mechanism for the development of autoimmune diseases in malnutrition remains unclear.

Interleukin-18 correlates with interleukin-4 but not interferon-gamma production in the lymphocyte cultures of atopic dermatitis patients after staphylococcal enterotoxin B stimulation.

BACKGROUND Staphylococcus aureus (S. aureus) triggers exacerbation of atopic dermatitis (AD) and causes chronic inflammation through the action of various proteins such as staphylococcal enterotoxin B (SEB). SEB has a role in activating interleukin (IL)-18, an important regulator of interferon (IFN)-γ and IL-4, in regards to a therapeutic strategy. OBJECTIVE To determine the correlation of IL-18 level with the IL-4 and IFN-γ level in lymphocyte cultures from AD patients following SEB stimulation. METHOD Twenty patients with AD based on the Hanifin and Rajka criteria and 20 healthy subjects as a control group were selected. A 5 ml blood sample from each subject was taken for lymphocyte culture. The culture was stimulated with SEB for two days and the outcomes were assessed by enzyme-linked immunosorbent assays (ELISA) to evaluate the levels of IL-18, IL-4, and IFN-γ. RESULTS In the AD group, the levels of IL-18, IL-4, and IFN-γ in lymphocyte cultures with SEB were significantly increased compared with non-SEB exposed cells (each p<0.001); similar results were found in the control group. The level of IL-18 was significantly elevated in lymphocyte cultures with SEB stimulation in AD vs. control (p<0.05) and without SEB in AD vs. control (p<0.05). Furthermore, IL-18 levels were significantly correlated with IL-4 levels and score atopic dermatitis (SCORAD) values in AD patients with SEB (r=0.41, p<0.05; and r=0.70, p<0.05, respectively); on the in contrary, there was no correlation between IL-18 and IFN-γ levels (p=0.469). CONCLUSIONS Our results suggest that IL-18 is correlated with increased of IL-4 levels in SEB-stimulated AD lymphocyte cultures.