Case Report

Sindroma Steven–Johnson terinduksi carbamazepine: laporan kasus

Peter Prayogo Hsieh , Nurmawatin Nurmawatin, Nur Khalisah, Nurjannah Nurjannah, Olivia Iriani Tantu, Orlando Pikatan, Pradita Zulfi Karisma Diana

Peter Prayogo Hsieh
Departemen Ilmu Kesehatan Anak, Rumah Sakit Pusat Angakatan Laut Dr. Ramelan, Surabaya, Indonesia. Email: peter_prayogo@yahoo.com

Nurmawatin Nurmawatin
Departemen Ilmu Kesehatan Anak, Rumah Sakit Pusat Angakatan Laut Dr. Ramelan, Surabaya, Indonesia

Nur Khalisah
Departemen Ilmu Kesehatan Anak, Rumah Sakit Pusat Angakatan Laut Dr. Ramelan, Surabaya, Indonesia

Nurjannah Nurjannah
Departemen Ilmu Kesehatan Anak, Rumah Sakit Pusat Angakatan Laut Dr. Ramelan, Surabaya, Indonesia

Olivia Iriani Tantu
Departemen Ilmu Kesehatan Anak, Rumah Sakit Pusat Angakatan Laut Dr. Ramelan, Surabaya, Indonesia

Orlando Pikatan
Departemen Ilmu Kesehatan Anak, Rumah Sakit Pusat Angakatan Laut Dr. Ramelan, Surabaya, Indonesia

Pradita Zulfi Karisma Diana
Departemen Ilmu Kesehatan Anak, Rumah Sakit Pusat Angakatan Laut Dr. Ramelan, Surabaya, Indonesia
Online First: December 30, 2021 | Cite this Article
Hsieh, P., Nurmawatin, N., Khalisah, N., Nurjannah, N., Tantu, O., Pikatan, O., Diana, P. 2021. Sindroma Steven–Johnson terinduksi carbamazepine: laporan kasus. Intisari Sains Medis 12(3): 948-951. DOI:10.15562/ism.v12i3.1198


Background: Steven-Johnson syndrome (SJS) is characterized by skin, mucosal, and eyes lesions caused by complex immune mechanisms or hypersensitivity reactions. In children, SJS incidence isn’t well–known because its clinical profiles aren’t well–recognized. One of the causes of SJS is due to the use of drugs. This report aims to describe carbamazepine–induced SJS.

Case: Twelve–year–old girl came with oral lesions for 1 week preceded by vesicles all over her body. This happened 3 days after taking carbamazepine, and it was her first time consuming it. On examinations, she was alert but weak with good nutritional status, had an axillary temperature of 37.7°C. Both her eyes were red and watery. She developed multiple ulcers in her mouth with a hyperemic pharynx. There were vesicles all over her body, but no abnormalities were found on thorax and abdomen examinations. Laboratory tests results showed neutrophilia, lymphocytopenia, eosinophenia, and hyponatremia. She was then diagnosed with SJS and was hospitalized. The doctor advised her to stop taking carbamazepine, and she received D5 ½ NS 2,000 cc/ 24 hours, dexamethasone injection 3 x ½ ampule, paracetamol injection 3 x 500 mg, betamethasone cream, triamcinolone oral-based cream, and oral cetirizine 1 x 10 mg. After 8 days she was discharged in good condition.

Conclusion: SJS is characterized by skin, mucosal, and eyes lesions which are mostly caused by drugs. One of the most common drugs causing SJS is antiepileptic such as carbamazepine

 

 

Latar Belakang: Sindroma Steven - Johnson (SSJ) ditandai dengan berbagai tanda diantaranya kelainan kulit, mukosa orifisium, dan lesi pada mata yang disebabkan oleh reaksi kompleks imun atau hipersensitivitas. Angka kejadian SSJ pada anak tidak diketahui dengan pasti, hal ini kemungkinan disebabkan oleh manifestasinya yang kurang dikenali. Salah satu sebab timbulnya SSJ adalah oleh karena penggunaan obat-obatan. Laporan kasus ini ditulis dengan tujuan untuk memberi gambaran mengenai SSJ pada remaja akibat obat carbamazepine.

Kasus: Remaja perempuan berusia 12 tahun datang dengan luka pada mulut dan lidah sejak 1 minggu sebelumnya yang didahului oleh mata merah dan bintik merah berisi cairan di seluruh tubuh. Keluhan timbul 3 hari setelah mengkonsumsi carbamazepine dan ini adalah pertama kalinya pasien mengkonsumsi obat tersebut. Pada pemeriksaan ditemukan pasien sadar, tampak sakit berat, didapatkan status gizi baik, suhu tubuh 37,7°C, kedua mata hiperemis difus, hiperlakrimasi, ulkus multipel berkrusta pada bibir dan lidah disertai faring hiperemis. Ditemukan adanya vesikel generalisata namun tidak ditemukan kelainan pada pemeriksaan thoraks dan abdomen. Hasil laboratorium menunjukkan neutrofilia, limfopenia, eosinopenia, dan hiponatremia. Pasien didiagnosis dengan SSJ. Pasien disarankan untuk menghentikan carbamazepine dan mendapatkan terapi cairan D5 ½ NS 2.000 cc/24 jam, injeksi deksametason 3 x ½ ampul, injeksi parasetamol 3 x 500 mg, krim betametason, sediaan krim oral triamsinolon, dan cetirizine oral 1 x 10 mg. Setelah dirawat selama 8 hari pasien dinyatakan sembuh dan dipulangkan.

Simpulan: SSJ memiliki gambaran klinis yang melibatkan lesi pada kulit, mukosa orifisium, mata, dan sebagian besar dicetuskan oleh obat. Salah satu obat yang sering menyebabkan SSJ adalah obat antikonvulsan pada pasien yang memiliki kecenderungan genetik.

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