JURN Kasus Langka

AL Sweet
Sindrome
Sekunder
Akibat Oleh:

Meiloidosis
Andi Zilfiah Lantani (K1A1 15 159)

Pembimbing : dr. Hj. Rohana Sari

Suaib, Sp. KK
 PENDAHULUAN

MELIOIDOSIS:
Melioidosis adalah infeksi yang terjadi di Asia Selatan dan Australia yang disebabkan oleh
Burkholderia pseudomallei dengan berbagai manifestasi klinis yang meliputI pneumonia,
bakteremia, artritis dan abses yang dalam.

Sweet Syndrome:
Sindrom Sweet juga dikenal sebagai dermatosis neutrofilik demam akut (Acute Febrile
Neutrophilic Dermatosis). Sweet Sindrome adalah kelainan inflamasi yang jarang diketahui,
dimana terkait dengan saluran pernapasan dan infeksi saluran cerna, keganasan dan
penggunaan obat-obatan tertentu.
 EPIDEMIOLOGI
Melioidosis
Paling sering menyerang usia
dewasa dibandingkan anak-anak.
Perempuan laing sering di
bandingkan dengan laki-laki

Sweet Sindrome
Paling banyak menyerang wanita
dibandingkan dengan laki-laki
dengan usia rata-rata 30-60 tahun,
tetapi tidak jarang menyerang
anak-anak usia remaja.
 PRESENTASI KASUS
Seorang wanita Sri Lanka usia 53 tahun yang sebelumnya sehat datang dengan
demam tinggi, ulkus pada oral yang nyeri, odynophagia dan multipel limfadenopati
cervikal bilateral sejak 1 bulan. Penurunan nafsu makan dan berat badan (+). Pasien
juga discharging sinus di daerah submental dan blepharitis bilateral.

Pada pemeriksaan dermatologis menunjukkan adanya multipel papul dan plak

eritematosa lunak dengan bentuk mamillated dan lesi target dengan bagian tengah
kekuningan yang secara simetris tersebat pada area wajah, tubuh bagian atas dan
ekstremitas.

Pada kasus juga terdapat beberapa ulkus di bagian oral yang erosi dengan batas
eritematosa dan berfibrin pada bagian bibir, dan lidah serta mukosa buccal.
 PRESENTASI KASUS
Hasil Whole Blood menunjukkan leukositosis neutrofil ringan.

Aspirasi  dari cairan supuratif kelenjar getah bening submental menunjukkan adanya
pertumbuhan Burkholderia pseudomallei (B. pseudomallei). Titer antibodi
Melioidosis adalah> 10.240..

Histologi dari lesi kulit wajah dan lengan kiri menunjukkan infiltrate neutrofilik yang
menonjol pada dermis meluas ke lemak subkutan yang mendukung sweet
syndrome.

(LM-H&E 100x. Tampak infiltrat difus dan LM-H&E 400x. Tampak infiltrat difus dengan
perivaskular neutrofil di dermis. Epidermis Karyorrhecic debris pada dermis)
secara histologi dalam batas normal)
 PRESENTASI
KASUS

Pasien mulai menggunakan meropenem 2 g intravena setiap hari.

pasien menunjukkan perbaikan klinis yang cepat dengan hilangnya
lesi kulit dengan berkurangnya tanda inflamasi yang signifikan.
DISKUSI DAN
KESIMPULAN
● Sweet Sindrome adalah sebuah kondisi dermatologis langka yang ditandai
dengan tiba-tiba timbulnya demam, peningkatan jumlah neutrofil, lesi kulit
eritematosa yang lunak, dan infiltrat difus pada neutrofil mature pada bagian
retikular dermis dengan edema pada papilla dermis.

● Melioidosis kulit dapat muncul dengan ulkus, pustula, selulitis, atau lesi
eritematosa berkrusta

● Kemungkinan Sweet Sindrome yang terjadi dicurigai dengan penampakan

karakteristik lesi kulit. Selanjutnya, histologi dari lesi kulit menunjukkan
neutrofil dan neutrofilik debris yang prominen dan limfosit di dermis dan
subkutan lemak tanpa bukti vasculitis.

● Menariknya, meskipun keterlibatan mukosa oral dalam Sweet Sindrome pada

umumnya jarang, pasien kami memiliki keterlibatan terhadap mukosa mulut
seperti pseudomembran yang luas.
THANK
YOU
 Table of Contents

01 02 03
About the Discussion Diagnosis
Patient
Here you could describe
the topic of the section
Here you could describe
the topic of the section
Here you could describe
the topic of the section

04 05
Treatment Patient
Here you could describe
the topic of the section
Monitoring
Here you could describe
the topic of the section
Introduction
Mercury is the closest planet to the Sun and the
smallest one in the Solar System—it’s only a bit
larger than our Moon. The planet’s name has
nothing to do with the liquid metal, since it was
named after the Roman messenger god,
Mercury
 Identifying Information

Neptune Saturn Mercury

Saturn is the ringed one. It’s a gas
Neptune is the fourth-largest planet
giant, composed mostly of
by diameter in our Solar System
hydrogen and helium
Mercury is the closest planet to the
Sun and the smallest one in our
Solar System
 Identifying Information

Venus
Venus has a beautiful name and is the
second planet from the Sun. It’s terribly
hot—even hotter than Mercury—and its
atmosphere is extremely poisonous. It’s
the second-brightest natural object in the
night sky after the Moon
Mercury
Mercury is the closest planet to the Sun
and the smallest one in the Solar System
—it’s only a bit larger than our Moon.
The planet’s name has nothing to do with
the liquid metal, since it was named after
the Roman messenger god
Patient Medical History
❏Age: 25-35 2008
❏Gender: female Neptune is the fourth-largest
planet by diameter in our Solar
❏Allergies: none System

❏Location: Madrid,
Spain 2013
Saturn is the ringed one. It’s a
❏Habits: unhealthy gas giant, composed mostly of
hydrogen and helium
eating, sedentary
lifestyle 2019
Venus has a beautiful name and
is the second planet from the
Sun. It’s terribly hot
 Review of Systems

Neptune Saturn
Neptune is the Saturn is composed

01 farthest planet from

the Sun 02 mostly of hydrogen
and helium

Mercury Jupiter Mars

Mercury is the This gas giant is the Despite being red,

03 smallest planet in
our Solar System 04 biggest planet in our
Solar System 05 Mars is actually a
cold place
 Physical Examination

Neptune Saturn Mars Venus Mercury

45% 12% 78% 36% 62%

To change the size of Yes, Saturn is the Mars is a cold place Venus has a beautiful Mercury is the closest
the graph, click the ringed one. It’s a gas full of iron oxide dust, name and is the planet to the Sun and
arc of the circle and giant, composed which gives the planet second planet from the smallest one our
drag one of the orange mostly of hydrogen its reddish cast the Sun. It’s terribly the Solar System
handles and helium hot
 4,497,374
Big numbers catch your audience’s attention
 Findings
Evolution Prevalence

32%
Pluto
24%
Venus

12%
Saturn
32%
Mars

If you want to modify this graph, click on it,

follow the link, change the data and replace it 200,000,000
Big number
Discussions

“Neptune is the farthest planet from the Sun

and the fourth-largest in our Solar System’’ Dr. John Doe

“Venus has a beautiful name and is the second

planet from the Sun. It’s terribly hot’’ Dr. Jenna James

“Mercury is the closest planet to the Sun and Dr. Daniel

the smallest one in our Solar System’’
Patterson
Discussions Summary

01
Venus has a beautiful name and is the second
planet from the Sun. It’s terribly hot and its
atmosphere is extremely poisonous

02
Jupiter is a gas giant and the biggest planet in our
Solar System. It’s also the fourth-brightest object
in the sky

03
Mercury is the closest planet to the Sun and also
the smallest one in our Solar System. It’s only a
bit larger than our Moon
 03
Diagnosis
You could enter a subtitle here if you need it
 Diagnosis
Neptune Mercury
Neptune is the fourth-largest Mercury is the closest planet to
planet by diameter in our Solar the Sun and the smallest one in
System our Solar System

Saturn Mars
Saturn is the ringed one. It’s a Despite being red, Mars is
gas giant, composed mostly of actually a cold place. It’s full of
hydrogen and helium iron oxide dust

Venus Jupiter
Venus has a beautiful name and It’s the fourth-brightest object in
is the second planet from the the sky and the biggest planet in
Sun. It’s terribly hot our Solar System
 Comparison

01 02 03 04
Saturn

Venus

Jupiter

Pluto
 04
Treatment
You could enter a subtitle here if you need it
 Treatment
Mars is full of iron oxide
Week 1 dust, which gives the planet
its reddish cast

Saturn is the ringed one. It’s

a gas giant, composed of
hydrogen and helium
Week 2

Venus has a beautiful name

Week 3 and is the second planet
from the Sun

Jupiter is a gas giant and the

biggest planet in our Solar
System
Week 4
A Picture
Always
Reinforces the
Concept
A Picture Is
Worth a
Thousand
Words
05
Patient Monitoring
You could enter a subtitle here if you need it
 Patient Monitoring
Week 1 Week 2
To change the size of the graph, click the circle and drag the colored handle
Venus has a beautiful name and is the
second planet from the Sun
Venu Satur
Mars Pluto
Venus s n

Mars

Saturn Week 3
Mercury is the
Venu Satu
Marss rn
closest planet to the
Pluto Sun Plut
o
 Contraindications - Indications
Saturn is the ringed one. It’s a Despite being red, Mars is
gas giant, composed of actually a cold place. It’s full
hydrogen and helium of iron oxide dust

Jupiter is a gas giant and the

Neptune is the fourth-largest
fourth-brightest object in the
planet in our Solar System
sky

Venus has a beautiful name Pluto is in the Kuiper belt and

and is the second planet from is considered a dwarf planet
the Sun since 2006

Mercury is the closest planet Ceres is a dwarf planet and

to the Sun and the smallest in the biggest object in the
our Solar System asteroid belt
 Post-prevention

Jupiter is a gas giant and

the biggest planet in our
Jupiter Mercury Mercury is the smallest
planet in our Solar
Solar System System

Venus is terribly hot and

its atmosphere is
Venus Mars Despite being red, Mars
is actually a cold place
extremely poisonous

Neptune is the fourth-

largest planet in our
Neptune Saturn It’s a gas giant,
composed mostly of
Solar System hydrogen and helium
 Case Timeline

Phase 1 Phase 2 Phase 3 Phase 4

Neptune is the fourth- Saturn is the ringed one. Venus has a beautiful name Mars is full of iron oxide
largest planet in our Solar It’s a gas giant, composed and is the second planet dust, which gives the planet
System of hydrogen and helium from the Sun its reddish cast
 Conclusions
Mercury is the closest planet to the Sun
and the smallest one in the Solar
System—it’s only a bit larger than our
Moon. The planet’s name has nothing to
do with the liquid metal, since it was
named after the Roman messenger god,
Mercury
 References

● AUTHOR (YEAR). Title of the publication. Publisher

● AUTHOR (YEAR). Title of the publication. Publisher

● AUTHOR (YEAR). Title of the publication. Publisher

● AUTHOR (YEAR). Title of the publication. Publisher

● AUTHOR (YEAR). Title of the publication. Publisher

● AUTHOR (YEAR). Title of the publication. Publisher

 Our Team

Helena James John Doe Jenna

Here you can talk a bit Here you can talk a bit Patterson
Here you can talk a bit
about this person about this person about this person
Thank
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