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Ulkus dekubitus pada seorang remaja perempuan dengan pemfigus vulgaris dan malnutrisi: laporan kasus

  • Michelle Hendrayanta ,
  • Ni Luh Putu Ratih Vibriyanti Karna ,
  • Ricky Setiawan ,
  • Giorgio Barnes Komala ,

Abstract

Background: Pressure ulcers are skin and underlying tissue injuries due to pressure, shear, or friction that cause hypoperfusion and lead to necrosis. Pemphigus vulgaris (PV) is a chronic intra-epidermal bullous disease that has the potential to cause extensive bullae and erosions. Erosion caused by PV is one of the risk factors for pressure ulcers. The condition is exacerbated by malnutrition, which inhibits wound healing due to a deficiency of essential nutrients needed in the wound-healing process. This case report will describe a case of PV, malnutrition, and pressure ulcers and aim to improve understanding of PV conditions with comorbidities that may complicate the healing process.

Case: An 18-year-old female with primary complaints of wounds on the mouth and body accompanied by ulcers on the buttocks, which were initially small and then increasingly enlarged. Mouth sores made it difficult for the patient to eat until she lost weight. A history of blisters appeared on both armpits and burst into sores. Physical and dermatologic examination revealed low body weight (body mass index 14.5 kg/m2), multiple mouth and whole body erosions, and a solitary ulcer on the sacrum region. Laboratory examination revealed hypoalbumin. The patient was diagnosed with pemphigus vulgaris along with grade III pressure ulcers and malnutrition. Clinical and laboratory improvement was improved after holistic and multidisciplinary medical and non-medical therapy.

Conclusion: Clinical wounds in PV lead to impaired nutritional intake, impacting the wound healing process. Management of underlying disease and comorbid conditions through a multidisciplinary approach is necessary to reduce morbidity and accelerate wound healing.

 

Latar Belakang: Ulkus dekubitus merupakan cedera pada kulit dan jaringan di bawahnya akibat dari tekanan, geseran maupun gesekan yang menyebabkan hipoperfusi berujung nekrosis. Pemfigus vulgaris (PV) adalah penyakit bula intra-epidermal kronik yang berpotensi menyebabkan bula dan erosi yang luas. Erosi yang diakibatkan oleh PV menjadi salah satu faktor risiko ulkus dekubitus. Kondisi diperparah dengan adanya malnutrisi yang menghambat penyembuhan luka dikarenakan adanya defisiensi zat-zat nutrisi penting yang dibutuhkan dalam proses penyembuhan luka. Laporan kasus ini akan menjelaskan sebuah kasus PV yang disertai dengan malnutrisi dan ulkus dekubitus serta bertujuan untuk meningkatkan pemahaman mengenai kondisi PV dengan penyakit penyerta yang dapat mempersulit proses penyembuhan.

Kasus: Perempuan usia 18 tahun dengan keluhan luka pada mulut dan seluruh tubuh disertai luka pada bokong yang awalnya kecil kemudian semakin membesar. Luka pada mulut membuat pasien sulit makan hingga mengalami penurunan berat badan. Riwayat muncul gelembung berair pada kedua ketiak dan pecah menjadi luka. Pemeriksaan fisik dan dermatologis didapatkan berat badan rendah (indeks massa tubuh 14,5 kg/m2), erosi multipel pada mulut dan seluruh tubuh serta ulkus soliter pada regio sakrum. Pemeriksaan laboratorium ditemukan hipoalbumin. Pasien didiagnosis pemfigus vulgaris disertai ulkus dekubitus grade III dan malnutrisi. Pasca terapi medikamentosa dan non-medikamentosa secara holistik dan multidisiplin ditemukan perbaikan klinis dan laboratorium.

Simpulan: Klinis luka pada PV menyebabkan gangguan asupan nutrisi yang dapat berdampak pada proses penyembuhan luka. Penanganan penyakit dasar serta kondisi penyerta melalui pendekatan multidisiplin diperlukan untuk dapat mengurangi morbiditas dan percepatan penyembuhan luka.

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How to Cite

Hendrayanta, M., Karna, N. L. P. R. V., Setiawan, R., & Komala, G. B. (2024). Ulkus dekubitus pada seorang remaja perempuan dengan pemfigus vulgaris dan malnutrisi: laporan kasus. Intisari Sains Medis, 15(1), 97–102. https://doi.org/10.15562/ism.v15i1.1398

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Michelle Hendrayanta
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Pubmed
ISM Journal


Ni Luh Putu Ratih Vibriyanti Karna
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ISM Journal


Ricky Setiawan
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ISM Journal


Giorgio Barnes Komala
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ISM Journal