PRESENTED BY A.

Isra Azreani (C111 09 816) Nor Farhana (C 111 09 870) Nur Nadia (C 111 08 776)

Identity
Name

: Tn Uddin Age : 27 years old Adress : Kampung Beru, Kel. PAO, Kab. Jeneponto Marital status : Married Admission Date : 12 December 2013

History taking
auto anamnesis Main problem :
Wounds at the face, both hands and feet area

Systematic history taking :

Wounds at the face, both hands and feet area appear

since 2 weeks ago. At first red discoloration appear on most part of the body after a fever and later nodules appear and burst out became wounds. Patient feel pain all over the body. History of drinking medication MDTMB from the Puskesmas for 1 year ago (since the last March of 2012). History of drugs allergy and food is denied. History of drug intake suddenly stop is denied.

Present status
General condition
Mild disease Conscious Good nutritional status Good hygiene

Head

Vital sign
Blood pressure : 120/90 mmHg Pulse

: 100 x/i Respiratory rate: 20 x/I Body temperature: 36.5 oc

: icterus (-) Conjunctiva : anemia (+) Lips : cyanosis (-) Heart/Lung Within normal limit Abdomen Within normal limit Lymph nodes Within normal limit

Sclera

Dermatovenerology status

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Treatment
Sistemic
Methylprednisolone (3-3-0)

Ofloxacin (1-0-0)
Neurodex 1x1

Topical

Resume

A male patient, 27 years old came to the hospital with main complaint of wounds at the face, both hands and feet area appear since 2 weeks ago. Pain (+). At first red discoloration appear on most part of the body after a fever(+) and later nodules appear and burst out became wounds. History of drinking medication MDT-MB from the Puskesmas for 1 year ago (since the last March of 2012). From the physical examination, we can found out there is macules, hipopigmentation and erosion at the face with the size about 2 cm. At the abdomen area, we can found out there is macules, hipopigmentation and hiperpigmentation with the size about 1-2 cm. At both the hands and feet, we can found out there is macules, hipopigmentation ulcus, crusta, erosion and pus with the size about 2.5 cm.

Theory
Leprosy is a chronic infectious disease, caused by

Mycobacterium leprae is an obligate intracellular. affinity peripheral nervous as the first, then the skin and upper respiratory tract mucosa, can then to other organs except the central nervous system.

Leprosy Reaction
There are 2 types of leprosy reactions, namely the type

of ENL and reversal. Leprosy reactions is the interrupt with an acute episode on the actual course of the disease is very chronic. ENL mainly occur in polar lepromatous type and can also be in the BL, means that the higher the level the more likely its multibasilar onset of ENL.

Clinical features

PB
1-5 Lesi Hipopigmentasi/ eritema Distribution unsimetry Lose of sensation clearly Only one neurologic nerve was disturbed

MB
> 5 lession Simetrical distribution Lose of sensation unclearly Many neurological nerve was disturbed

Diagnosis
For diagnose Leprosy according to clinical

manifestation, bacterioskopis, and histopatologis, and serologic. Between the third, clinical diagnosis is most important and simple. Bacteriascopic need 15-30 minutes, while histopatologic need 10-14 days. Clinical finding of leprosy (+), if one of cardinal sign present. The cardinal sign are: anestesi plaque, process thickening of neural with lose function, and BTA examination (+).

Diagnostic Examination
In this patient, we suggest to do laboratory

examination include:
Bacterioscopic examination Histopatologic examination Serologic examination

Treatment

Prognosis
Recovery from neurologic impairment is limited, but

skin lesions generally clear within the first year of therapy. Discoloration and skin damage typically persist. Physical therapy, reconstructive surgery, nerve and tendon transplants, and surgical release of contractures have all contributed to increasing the functional ability in patients with leprosy. A common residual deformity is insensitive feet, as seen in persons with diabetes.

MULTIDRUG THERAPY/WHO SCHEME FOR THE TREATMENT OF LEPROSY Rifampin Clofazimine Dapsone Ofloxacin Minocycline Therapy duration MB (>5 lesions[*]) PB (25 lesions[*]) PB (single lesion[*]) 600 mg once 300 mg once 100 mg daily monthly monthly and 50 mg daily 600 mg once monthly 600 mg 1 100 mg daily 12 blister packs over 12 to 18 months 6 blister packs over 6 to 9 months Single dose

400 mg 1

100 mg 1

Dose adjustments for children 10 to 14 years 450 mg once 150 mg once 50 mg daily of age, MB[] monthly monthly and 50 mg every other day
<10 years of age, MB[] 300 mg once monthly 100 mg once monthly and 5 to 14 years of 300 mg 1 age, single lesion PB 50 mg twice weekly 25 mg daily

12 blister packs over 12 to 18 months 12 blister packs over 12 to 18 months

200 mg 1

50 mg 1

Single dose