<p>Terapi lesi oral pasien sindrom Stevens-Johnson disertai lupus eritematosus sistemik</p><p>Oral lesion therapy in patients with Stevens-Johnson syndrome with systemic lupus erythematosus</p>

Abstract

Pendahuluan: Adverse drug reaction (ADR) merupakan salah satu respon tubuh manusia tidak diinginkan dan berbahaya yang disebabkan penggunaan obat meskipun dalam dosis normal. ADR dapat menyebabkan terjadinya sindrom Stevens-Johnson (SJS) serta dapat memicu lupus eritematosus sistemik (SLE), yang salah satu manisfestasinya sebagai krusta hemoragik dan erosi yang luas pada mulut dan peri–oral, dapat mengganggu fungsi mulut sehingga terganggunya asupan makanan. Laporan kasus ini bertujuan untuk menjelaskan terapi lesi oral pasien sindrom Stevens-Johnson disertai lupus eritematosus sistemik. Laporan kasus: Seorang pasien wanita berusia 57 tahun dengan riwayat penyakit meningitis tuberkulosis dirujuk ke Bagian Penyakit Mulut dari departemen Ilmu Kesehatan Kulit dan Kelamin dengan diagnosis SJS, pasien mengeluhkan kesulitan untuk membuka mulutnya, sakit menelan dan sakit pada bibir. Terdapat riwayat pemakaian obat ofloxacin, streptomysin, dan OAT. Pemeriksaan ekstraoral menunjukkan beberapa lesi diskret pada wajah, konjungtiva anemis, lesi erosif dan krusta hemoragik pada bibir. Pemeriksaan intraoral ditemukan lesi erosif pada mukosa bukal dan palatal serta plak putih pada dorsal lidah. Pemeriksaan darah rutin menunjukkan hemoglobin, hematokrit, leukosit, MCV, MCH, eosinofil, netrofil, limfosit, protein total dan albumin rendah sedangkan uji ANA positif, sehingga diagnosis ditegakkan sebagai lesi oral terkait SJS disertai SLE dan kandidiasis oral. Medikasi yang diberikan adalah Chlorhexidine gluconate 0,1%, nistatin suspensi oral, vitamin B12, asam folat, dan topikal kortikosteroid. Lesi oral menunjukkan perbaikan dalam waktu 3 minggu, pada pasien terjadi SJS dan SLE secara bersamaan hal ini menunjukkan adanya keterlibatan mekanisme imunologi Simpulan: Terapi non farmakologi berupa pemberian kortikosteroid topikal,obat kumur Chlorhexidine gluconate 0,1%, vitamin B12, asam folat, dan nistatin yang menunjukkan perbaikan pada lesi oral dalam 3 minggu perawatan, di tambah dengan terapi non farmakologi berupa pemeliharaan kebersihan rongga mulut dengan obat kumur Chlorhexidine gluconate 0,1% sebagai antiseptik untuk meningkatkan kenyamanan pasien, untuk memfasilitasi epitelisasi dan mencegah komplikasi seperti infeksi. Kata kunci: Adverse Drug Reaction, lesi oral, sindrom Stevens-Johnson, lupus eritematosus sistemik. ABSTRACT Introduction: Adverse drug reaction (ADR) is one of the unwanted and dangerous human body responses caused by the use of medications even in regular doses. ADR can cause Stevens-Johnson syndrome (SJS) and trigger systemic lupus erythematosus (SLE), with manifestation such as extensive haemorrhagic and erosive crusts in the mouth and peri-oral, which can interfere the oral function and disrupt the food intake. This case report was aimed to explain the treatment of oral lesions in patients with Stevens-Johnson syndrome with systemic lupus erythematosus. Case report: A 57-years-old female patient with a history of tuberculous meningitis was referred to the Oral Medicine Department of the Skin and Gynecology Polyclinics with a diagnosis of SJS, chief complaints of difficulty in opening her mouth, ingesting, and lips soreness. There was a medication history of ofloxacin, streptomycin, and OAT drugs. Extraoral examination indicated several facial discrete lesions, anaemic conjunctiva, erosive lesions, and hemorrhagic crusts on the lips. The intraoral examination found erosive lesions of the buccal and palatal mucosa and white plaques on the dorsal tongue. Routine blood tests showed the low level of haemoglobin, haematocrit, leukocytes, MCV, MCH, eosinophils, neutrophils, lymphocytes, and also low total protein and albumin, while the ANA test was positive. Thus the diagnosis was established as oral lesions associated with SJS with SLE and oral candidiasis. Medications administered were 0.1% chlorhexidine gluconate, nystatin oral suspension, vitamin B12, folic acid, and topical corticosteroids. Improvement in the oral lesions healing occurred within 3 weeks. SJS and SLE symptoms were simultaneously occurred in the patient, showed the involvement of immunological mechanisms. Conclusion: Non-pharmacological therapy in the form of topical corticosteroids, 0.1% chlorhexidine gluconate mouthwash, vitamin B12, folic acid, and nystatin, showed improvement in oral lesions within 3 weeks of treatment, added by non-pharmacological therapy in the form of maintaining oral hygiene with 0.1% Chlorhexidine gluconate mouthwash as an antiseptic to improve the patient’s comfort, and facilitate the epithelialisation and prevent complications such as infections. Keywords: Adverse drug reaction, oral lesion, Stevens-Johnson syndrome, systemic lupus erythematosus.