Laporan Kasus Pyoderma Gangrenosum disertai Kandidiasis Kutis pada Wanita dengan Sindrom Metabolik

Abstract

Introduction: Pyoderma gangrenosum (PG) is a rare inflammatory disease characterized by sterile, predominantly neutrophilic infiltration of the skin and other organs. PG is found particularly in women aged between 40-60 years. Metabolic syndrome is reported to have a potential role to induce PG. Case: A 45-year-old woman came to Dr. Moewardi Hospital with chief complaints of ulcer in the chest and legs that was preceded by reddish fluid filled bump which then broke into painful wound. History of trauma, gastrointestinal, and joint pain was denied. Dermatological examination of anterior trunk region and inferior extremity showed erythematous patches with multiple ulcers with irregular border covered with hemorrhagic crusts and necrotic tissue. Pathergy test was negative. In the right and left axillary, inframammary and inguinal, there were hyperpigmented patches with scales and satellite lesions, KOH 10% examination obtained pseudohyphae and cell budding. The patient also has metabolic syndrome. Diagnosis of PG was made based on the presence of 2 major and 2 minor criteria. Patient was given intravenous methylprednisolone 93.75 mg/24 hours, analgesics, antibiotics, topical antifungals, debridement and breast reconstructive surgery after response to steroid therapy was seen. The patient was discharges from hospital with improvement. Discussion: Metabolic syndrome is considered to be a risk factor contributing to the development of systemic chronic inflammatory processes and has been described as one of the precipitating factors for PG and skin candidiasis. Management of metabolic syndrome as the known risk factor aims to minimize the recurrence of PG in the future.Pendahuluan: Pyoderma gangrenosum (PG) adalah suatu penyakit inflamasi yang jarang terjadi, ditandai dengan infiltrasi steril yang didominasi neutrofil pada kulit maupun organ tubuh lain. PG umumnya dijumpai pada wanita usia 40−60 tahun. Sindrom metabolik dilaporkan memiliki hubungan potensial dalam mencetuskan pyoderma gangrenosum. Kasus: Seorang wanita berusia 45 tahun datang ke RSUD Dr. Moewardi dengan luka di dada dan kaki diawali blister kemerahan berisi cairan yang pecah menjadi luka yang terasa nyeri. Riwayat trauma, keluhan saluran pencernaan, dan nyeri sendi disangkal. Pemeriksaan dermatologi regio trunkus anterior et ektremitas inferior tampak patch eritem dengan ulkus multipel di atasnya, tepi irregular sebagian tertutup krusta hemoragi dan jaringan nekrotik. Hasil tes pathergy negatif. Regio aksilaris dextra et sinistra, inframammae et inguinal tampak patch hiperpigmentasi dengan skuama tipis dan lesi satelit, pada pemeriksaan KOH 10% tampak pseudohifa dan cell budding. Pasien memiliki kondisi sindrom metabolik. Diagnosis PG memenuhi 2 kriteria mayor dan 2 minor. Tata laksana pada pasien menggunakan methylprednisolone intravena 93,75 mg/24 jam, analgesik, antibiotik, antifungal topikal, dan debridement serta breast reconstructive surgery setelah respons terapi steroid terlihat. Pasien pulang dalam keadaan perbaikan.Diskusi: Sindrom metabolik dianggap sebagai faktor pencetus PG melalui proses inflamasi kronis sistemik. Pentingnya tata laksana pada faktor pencetus bertujuan untuk menghindari PG berulang.