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KESELAMATAN PASIEN

KEPUASAN PASIEN
CASE REPORT
Wednesday, November 1 st 2023

CAKRA ( Cepat, Aman, Komunikatif, Ramah, Akuntable)

Verruca vulgaris
Presenters
dr. Cok Istri Sadwitri Pemayun, S. Ked,
dr. Adam Mici Gandana

Moderator/Mentor
dr. Angel B. Wisan, M. Kes, Sp. DVE,
 PATIENT ID
• Name :NMS
• Gender : Famale
• Age : 67 years old
• Nationality : Indonesian
• Religion : Hindu
• Address :-
• Medical record : 14.30.4
• Date of admission : Monday Sept 11th 2023 at 08.00 am
 ANAMNESIS
Main Complaint : Tumor on Auricula Dekstra

• Pasien datang ke poli kulit dengan keluhan benjolan kecil pada

telinga kanan sejak 4 bln SMRS.
 ANAMNESIS
PAST HISTORY

• Benjolan semakin membesar. 1 bln SMRS pasien membeli obat sendiri di

apotek dan membeli obat yang tidak bermerk dari market place online.
• Setelah di oleskan selama 1 bln, benjolan tidak hilang tapi semakin
membesar dan terdapat perlukaan di permukaan kulit.
• Pasien baru kali ini mendapat keluhan seperti ini.

FAMILY HISTORY

• Tidak ada riwayat alergi atau keturunan dari keluarga.

 ANAMNESIS
MEDICINE HISTORY
• Tidak tahu merk obat nya

ALLERGY HISTORY
• There was no allergy history.
ECONOMIC AND SOCIAL LIFE HISTORY

• Patient live with her family.

 PHYSICAL EXAMINATION
Present status
• General condition : compos mentis
• Consciousness : E4V5M6
• Blood Pressure : 126 / 76 mmHg
• Heart Rate : 94x / mnt
• Respiratory Rate : 20x / mnt
• Axilla Temperature : 36.0 celcius degree
• O2 Saturation : 99% RA
 PHYSICAL EXAMINATION
General Status
• Head : normocephalic
• Eyes : conjunctival injection (-), anemic (+/+),
icteric sclera (-), pupillary reflex (+/+)
• ENT :
Ear : secrete (-)
Nose : nasal breathing (-)
Throat : not hyperemic
Lips : cyanosis (-)
Neck : JVP normal, enlargement of the gland (-)
 PHYSICAL EXAMINATION
General Status
• Cardiac
Inspection : ictus cordis pulsation (-), precordial
bulging (-)
Auscultation : S1S2 normal reguler, no murmur
• Lungs
Inspection : symmetrical, retraction (-)
Palpation : chest movement : symmetric
Auscultation : vesicular +/+, Rales -/-, Wheezing -/-
 PHYSICAL EXAMINATION
• Abdomen
Inspection : Symmetrical, distention (-)
Auscultation : Bowel sound (+) normal
Palpation : Liver and spleen unpalpable
Percusion : Timpani
• Skin : No sianosis, rash (-), normal turgor
• Genitalia : d.b.n
• Extremities : Warm (+), edema (-), CRT ≤ 2”
 LOCALIZED STATUS

• Dermatology status :
Location : auricula dekstra
Papul eritema soliter, batas tegas, bentuk oval, ukuran 1 cm, dengan
permukaan verukosa
 LABORATORY/ RADIOLOGY FINDINGS

• none
 DIFERENTIAL DIAGNOSIS
• Cutaneous horn
• Veruka vulgaris
• Senile Keratosis
• Seborrheic keratosis
• Squamous cell carcinoma
• Molluscum contagiosum
 PLANNING
Polyclinic :
• Kompres nacl 0.9% selama 10 mnt 4x sehari
• Desoksimetason + kloramphenikol salep kulit tiap 12 jam topical
• Control kembali ke poli tanggal 20 sept 2023 u/ tindakan elektrokauter
Tindakan Elektrokauter
20 Sept 2023
DISCUSSION
S
 Introduction
• Common viral infection of skin and mucosal epithelial
cells
• Caused by human papilloma virus (HPV)
• Most infections clear within 2 years
 Epidemiology Etiology
• Could appear in any age -> 7-12% of • Infection of Human Papilloma
Virus (HPV)
population are mostly common in
children than adults • Common subtype HPV 1, 2, 4, 27
& 57
• Involving studies: school-age children
and teenagers who have been
infected show that about 50% of
them no longer have the lesions after
one year. After two years, about 70%
of them no longer had the lesions.
• Commonly happen in
immunosuppressant patient
 Patophysiology
• Spread via direct contact (skin to skin, indirect from the
environment or something which leading to the source of
infection)
• Viruses can survive in warm and humid environments.
• HPV invades the epidermal basal cells through microabrasions;
induces hyperplasia and hyperkeratosis
• Most infections are cleared by immune response
• Virus binding to the receptor → virus is internalized into the
cell by endocytosis → viral genome enters the nucleus
 Patophysiology
• E6 and E7 HPV proteins hijack the checkpoint mechanisms of
the cell cycle → uncontrolled proliferation
• Viral genome replication with increased levels of the E1, E2, E4
and E5 proteins
• In the terminally differentiated layer of epithelium L1 and L2
capsid proteins are expressed and viral particles are assembled
• The virions are sloughed off with the dead squamous cells of
the host epithelium for further transmission
 Clinical Feature
• Flesh colored papules with a rough surface
• Asymptomatic but grows to form hyperkeratotic lesions
that are well-defined and thickened
• occur in any part of the body where it spreads by direct
contact or autoinoculation
• The increase in the size of the lesion lasts from several
weeks to several months.
• The lesion is gray with a rough surface and is called
verrucus
• Histopathological examination can be used to confirm the diagnosis
Evaluation Differential Diagnosis
• The clinical picture of verruca • Senile Keratosis
vulgaris is a slowly enlarging
papule of varying size, • Seborrheic
hyperkeratotic, with a filiform
surface, well-defined lesions keratosis
• Histopathological examination • Squamous cell
can be used to confirm the
diagnosis carcinoma
• Molluscum
contagiosum
 Treatment Prognosis
• Usually well-prognosis
• Salicylic acid
but it is often recurrent
(concentration 12- despite adequate
17% or can be up to treatment.
50% in ointment)
• Electrocauter
• Cryotherapy
• Topical cidofovir, oral
retinoids (other
cinsiderations)
 Conclusions
• Female, 67 years old with diagnosis : veruka
vulgaris
• Verruca vulgaris is a verrucous papule caused by
infection with the human papilloma virus (HPV)
• The spread of verruca vulgaris can be direct
through skin-to-skin contact or indirectly through
the environment.
 CONCLUSION
• Verruca vulgaris can appear at any age, but is rare in
babies and young children.
• The disease is mostly asymptomatic but grows to form
hyperkeratotic lesions that are well defined and
thickened.
• Treatment of verruca vulgaris depends on the number,
morphology, and distribution of warts
THANK YOU