Satu kasus nekrolisis epidermal toksik yang diduga disebabkan oleh kotrimoksasol

Abstract

Abstract: Toxic epidermal necrolysis (TEN) is an acute life-threatening muco-cutaneous reaction, characterized by extensive necrosis and detachment of the epidermis (>30% BSA). Drugs are often suspected as the main cause, one of which is trimethoprim- sulfamethoxazole (TMP-SMX). Management includes immediate termination of alleged drugs, supportive treatment such as maintenance of electrolyte balance, nutrition, analgesics, antibiotics and specific treatment of immunosuppressants with dexamethasone injection. We reported a female 36 yo who complained of dark red spots and flaky skin on the face, chest, abdomen, back, arms, and genitals associated with fever, dysphagia, and sore eyes. There was a history of cotrimoxazole consumption prior to the rashes. Skin examination revealed multiple, well defined, erythematous macula, numular to plaque-sized, multiple bullae, purpura, erosion, crusts, and epidermolysis on the face, chest, abdomen, back, and upper extremities. Patient also had vulval erosion and conjunctival hyperemia. Laboratory tests showed total protein 6.5 g/dL and albumin 3.2 g/dL. Patient was treated with intravenous RL:D 5%:NaCl 0.9% = 1:1:1 20 gtt/min, ranitidine injection 2x25 mg IV, ceftriaxone injection 1x2 gr IV, NaCl 0.9% moist dressing 3x30 minutes on erosions, polymyxin B sulphate, neomycin sulphate and dexamethasone eye drops 4x1gtt, artificial tears 6x1gtt, and tapered dexamethasone injection 4x10 mg IV. Diagnosis of TEN was established through anamnesis, physical examination, and laboratory examination. Patient showed clinical improvement within 2 weeks after the discontinuation of cotrimoxazole, and administration of supportive and specific treatment.
Keywords: toxic epidermal necrolysis, cotrimoxazole

Abstrak: Nekrolisis epidermal toksik (NET) merupakan reaksi mukokutan akut yang mengancam jiwa, ditandai nekrosis dan pelepasan epidermis yang luas (>30% LPB). Obat diduga sebagai penyebab utama, salah satunya ialah golongan trimetoprim-sulfametoksazol (TMP-SMX). Penatalaksanaan meliputi penghentian segera obat yang diduga penyebab, penanganan suportif (keseimbangan elektrolit, nutrisi, analgetik, antibiotik) dan pengobatan spesifik (imunosupresan deksametason injeksi). Kami melaporkan kasus seorang perempuan 36 tahun dengan bercak merah kehitaman dan kulit terkelupas di wajah, dada, perut, punggung, kedua lengan, dan kelamin disertai demam, nyeri menelan, dan kemerahan pada mata. Riwayat konsumsi kotrimoksazol sebelum timbul ruam. Status dermatologikus: pada wajah, dada, perut, punggung, kedua lengan atas dan bawah terdapat makula eritematosa, batas tegas, multipel, ukuran numular-plakat; bula, purpura, erosi, krusta, dan epidermolisis. Terdapat erosi vulva erosi dan konjungtiva hiperemis bilateral. Pemeriksaan laboratorium: protein total 6,5 g/dL dan albumin 3,2 g/dL. Penanganan berupa IVFD RL:D 5%:NaCl 0.9% = 1:1:1 20 tetes/menit, injeksi ranitidin 2x25 mg IV, injeksi seftriakson 1x2 gr IV, kompres terbuka NaCl 0,9% 3x30 menit (luka), obat tetes mata (polimiksin B sulfat, neomisin sulfat dan deksametason) 4x1 tetes, air
Gunawan, Wibawa, Suling, Niode: Satu kasus nekrolisis epidermal toksis ...
mata buatan 6x1 tetes dan injeksi deksametason 4x10 mg IV yang diturunkan secara bertahap sesuai perbaikan klinis. Diagnosis NET pada kasus ini ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang. Keadaan umum pasien membaik dalam 2 minggu setelah dilakukan penghentian obat yang diduga penyebab, penanganan suportif, dan pengobatan spesifik.
Kata kunci: nekrolisis epidermal toksik, kotrimoksazol