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Efusi pleura pada tuberkulosis ekstra paru dengan riwayat lupus eritematosus sistemik di Puskesmas Sukasada II: sebuah laporan kasus



Abstract

Background: Infection is a complication that contributes to morbidity and mortality in SLE patients. Tuberculosis (TB) is an infection that is of particular concern, especially for those living in endemic areas such as Indonesia. Pleural TB is the second most common form of extrapulmonary tuberculosis after lymphatic involvement and is the most common cause of pleural effusion. This case report describes a case of pleural effusion in extrapulmonary tuberculosis with a history of systemic lupus erythematosus for the purpose of determining appropriate management.

Case presentation: A 42-year-old woman complained of fever for 2 weeks, non-productive cough, lower right chest pain when coughing, and shortness of breath. The patient has a history of controlled SLE disease with medication since one year ago. On physical examination found decreased vocal fremitus right chest, dull percussion on the right chest, decreased vesicular breath sounds in the lower right lung. Complete blood count and blood chemistry showed normal results, chest X-ray showed right pleural effusion with pulmonary infiltrate on the ipsilateral pleural effusion, pleural fluid analysis showed an exudate, and adenosine deaminase levels were more than laboratory reference values. This patient was diagnosed with right pleural effusion et causa pleural TB. Management includes evacuation of pleural fluid, administering rivastar therapy at the hospital followed by 2RHZE/4RH anti-tuberculosis drugs at the Sukasada II Health Center. Significant improvement was evident by the reduced number of pleural effusions and pulmonary infiltrates on the chest X-rays of the patients in the second and final month of treatment.

Conclusion: Pleural effusion in extrapulmonary TB patients with a history of SLE can be diagnosed through history, physical examination and supporting examinations such as radiography, pleural fluid analysis and histology. Treatment and monitoring of TB in SLE patients is in line with national guidelines for TB patients without SLE.

 

Latar Belakang: Infeksi merupakan komplikasi yang berkontribusi terhadap morbiditas dan mortalitas pada pasien SLE. Tuberkulosis (TB) merupakan salah satu infeksi yang menjadi perhatian khusus terutama bagi mereka yang tinggal didaerah endemik seperti di Indonesia. TB pleura adalah bentuk paling umum kedua dari tuberkulosis ekstra paru setelah keterlibatan limfatik dan merupakan penyebab paling umum dari efusi pleura. Laporan kasus ini mendeskripsikan kasus efusi pleura pada tuberkulosis ekstra paru dengan riwayat lupus eritematosus sistemik agar tepat dalam menentukan tatalaksana yang tepat.

Presentasi kasus:  Perempuan 42 tahun mengeluh demam selama 2 minggu, batuk non produktif, nyeri dada kanan bawah jika batuk, dan sesak. Pasien memiliki riwayat penyakit SLE terkontrol dengan pengobatan sejak satu tahun yang lalu. Pada pemeriksaan fisik ditemukan vokal fremitus dada kanan menurun, perkusi redup pada dada kanan, suara napas vesikuler menurun pada paru kanan bawah. Pemeriksaan darah lengkap dan kimia darah menunjukkan hasil normal, foto toraks menunjukkan efusi pleura kanan dengan gambaran infiltrat paru di ipsilateral efusi pleura, analisis cairan pleura menunjukkan suatu eksudat, dan kadar adenosine deaminase lebih dari nilai rujukan laboratorium. Pasien ini didiagnosis dengan efusi pleura dekstra et causa TB pleura. Tatalaksana meliputi evakuasi cairan pleura, pemberian terapi rivastar di rumah sakit dilanjutkan obat anti tuberkulosis 2RHZE/4RH di Puskesmas Sukasada II. Perbaikan yang signifikan terbukti dengan berkurangnya jumlah efusi pleura dan infiltrate paru pada foto toraks pasien bulan kedua dan akhir pengobatan.

Simpulan: Efusi pleura pada pasien TB ekstra paru dengan riwayat SLE dapat ditegakkan diagnosisnya melalui anamnesis, pemeriksaan fisik dan pemeriksaan penunjang seperti radiografi, pemeriksaan analisis cairan pleura dan histologi. Pengobatan dan monitoring TB pada pasien SLE sejalan dengan pedoman nasional pasien TB tanpa SLE.

Keywords: Efusi pleura ekstra paru lupus eritematosus sistemik tuberkulosis

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How to Cite

Hendrawardani, D. A. C. (2023). Efusi pleura pada tuberkulosis ekstra paru dengan riwayat lupus eritematosus sistemik di Puskesmas Sukasada II: sebuah laporan kasus. Intisari Sains Medis, 14(2), 497–503. https://doi.org/10.15562/ism.v14i2.1727
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