Unidentified angular recurrent ulceration responsive to antiviral therapy

• Main Authors: Rahmi Amtha (Author), Siti Aliyah Pradono (Author)
• Format: Book
• Published: Universitas Airlangga, 2013-03-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

<p><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><strong>Background</strong><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>: Recurrent ulcer on angular area is usually called stomatitis angularis. It is caused by many factors such as vertical </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>dimension reduce, vitamin B</em><span style="font-family: Tribune-Italic; font-size: 7pt; color: #231f20; font-style: normal; font-variant: normal;"><em>12, </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>and immune system deficiency, C. albicans and staphylococcus involvement. Clinically is characterized </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>by painful fissure with erythematous base without fever. </em><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><strong>Purpose</strong><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>: to describe an unidentified angular ulcer proceeded by recurrent </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>ulcers with no response of topical therapy. </em><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><strong>Case</strong><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>: An 18-years old male came to Oral Medicine clinic in RSCM who complained of </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>angular recurrent ulcers since 3 years ago which developed on skin and bleed easily on mouth opening. Patient had fever before the </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>onset of ulcers. Large, painful, irregular ulcers covered by red crustae on angular area bilaterally. Patient has been treated with </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>various drugs without improvement and lead to mouth opening limitation. Intra oral shows herpetiformtype of ulcer and swollen of </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>gingival. </em><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><strong>Case management</strong><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>: Provisional diagnosis was established as viral infection thus acyclovir 200 mg five times daily for two </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>weeks and topical anti inflammation gel were administered. Blood test for IgG/IgM of HSV1 and HSV2 were non reactive, however </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>ulceration showed a remarkable improvement. The ulcers healed completely after next 2 weeks with acyclovir. </em><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><strong>Conclusion: </strong><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>The </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>angular ulceration on above patient failed to fulfill the criteria of stomatitis angularis or herpes labialis lesion. However it showed a </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>good response to antiviral. Therefore, unidentified angular ulceration was appointed, as the lesion might be triggered by other type </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>of human herpes virus or types of virus that response to acyclovir.</em></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></p><p><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Italic; font-size: 7pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><strong>Latar belakang: </strong><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>ulser rekuren pada sudut mulut biasanya disebut stomatitis angularis. Kelainan ini disebabkan oleh banyak faktor </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>seperti berkurangnya dimensi vertikal, defisiensi vitamin B12 dan sistem kekebalan tubuh, infeksi C. albicans serta staphylococcus. Secara </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>klinis kelainan ini ditandai dengan fisur sakit pada sudut mulut dengan dasar eritematus tanpa disertai demam. </em><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><strong>Tujuan: </strong><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>Melaporkan </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>kasus ulser sudut mulut rekuren yang tidak biasa, tanpa respon terhadap terapi topikal yang biasa diberikan. </em><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><strong>Kasus: </strong><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>Seorang lakilaki berusia 18 tahun datang ke klinik Penyakit Mulut RSCM dengan keluhan ulser rekuren pada sudut mulut yang meluas ke kulit </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>sekitarnya sejak 3 tahun yang lalu. Ulser mudah berdarah saat pasien membuka mulut dan demam sebelum lesi timbul.
Ulser membesar, </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>bilateral, sakit, tepi tidak teratur, ditutupi oleh krusta merah. Pasien telah diobati dengan berbagai obat, namun tidak menunjukkan </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>perbaikan. Intra oral tampak ulser jenis herpetiformis pada gingiva disertai dengan pembengkakan. </em><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><strong>Tatalaksana kasus: </strong><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>Diagnosis </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>awal ditegakkan sebagai infeksi virus, oleh karena itu pasien diberikan acyclovir 200 mg lima kali sehari selama dua minggu dan gel </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>anti radang topikal. Walaupun hasil darah IgG/IgM HSV1 dan HSV2 non reaktif, namun ulserasi menunjukkan penyembuhan yang </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>luar biasa dengan anti virus yang diberikan. Ulser sembuh sempurna setelah pemakaian acyclovir 2 minggu berikutnya. </em><span style="font-family: Tribune-Bold; font-size: 10pt; color: #231f20; font-style: normal; font-variant: normal;"><strong>Kesimpulan: </strong><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>ulserasi sudut mulut pada pasien di atas gagal memenuhi kriteria stomatitis angularis atau herpes labialis. Namun ulser menunjukkan </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>respon yang amat baik terhadap antivirus. Diagnosis ditetapkan sebagai ulserasi sudut mulut yang tidak teridentifikasi. Kemungkinan </em><span style="font-family: Tribune-Italic; font-size: 9pt; color: #231f20; font-style: normal; font-variant: normal;"><em>lesi dipicu oleh virus herpes manusia jenis lain atau jenis virus yang memberikan respon terhadap asiklovir.</em></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><br style="font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px;" /></span></span></span></span></span></span></span></span></span></span></span></span></p>

Item Description

1978-3728
2442-9740
10.20473/j.djmkg.v46.i1.p30-34