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Abstrak :
ABSTRAK
Nekrosis avaskular adalah suatu kondisi di mana sel-sel tulang mati karena kurangnya aliran darah. Kondisi ini sering dijumpai pada pasien yang mengonsumsi kortikosteroid dosis tinggi. Sedangkan kortikosteroid dosis tinggi yang sering diberikan pada pasien Systemic Lupus Erythematosus (SLE) menunjukkan adanya hubungan antara AVN dan SLE karena regimen pengobatan itu sendiri. Hal ini memungkinkan untuk menyelidiki faktor mana pada pasien SLE yang dapat mempengaruhi perkembangan AVN. Metode: Sebanyak 22 rekam medis pasien dari RSUPN Cipto Mangunkusumo dicatat dan dianalisis. Sampel yang diambil terdiri dari pasien yang didiagnosis dengan SLE dan kemudian berkembang menjadi AVN. Setiap faktor risiko kemudian dianalisis untuk mengetahui besarnya signifikansi masing-masing faktor risiko terhadap AVN. Hasil: Dari semua faktor risiko yang dianalisis, hanya kortikosteroid dosis kumulatif (p <0,05) yang bermakna dengan terjadinya AVN. Faktor risiko lain tidak signifikan. SLEDAI dan antibodi antifosfolipid tidak dapat dianalisis karena kurangnya data. Kesimpulan: Kortikosteroid dosis tinggi akan mempengaruhi AVN sekunder pada pasien SLE sedangkan tidak ada hubungan yang pasti antara skor SLEDAI dan antibodi antifosfolipid.
ABSTRACT
Avascular necrosis is a condition in which bone cells die due to a lack of blood flow. This condition is often seen in patients taking high doses of corticosteroids. Meanwhile, high doses of corticosteroids that are often given to patients with Systemic Lupus Erythematosus (SLE) indicate a relationship between AVN and SLE because of the treatment regimen itself. This made it possible to investigate which factors in SLE patients might influence AVN development. Methods: A total of 22 patient medical records from RSUPN Cipto Mangunkusumo were recorded and analyzed. The sample taken consisted of patients who were diagnosed with SLE and later developed an AVN. Each risk factor was then analyzed to determine the significance of each risk factor for AVN. Results: Of all the risk factors analyzed, only the cumulative dose of corticosteroid (p <0.05) was significant with the occurrence of AVN. Other risk factors are not significant. SLEDAI and antiphospholipid antibodies could not be analyzed due to lack of data. Conclusion: High doses of corticosteroids will affect secondary AVN in SLE patients whereas there is no definite relationship between SLEDAI score and antiphospholipid antibodies.

Abstrak :
ABSTRAK
Salmonella as a causative agent in septic bursitis is considered rare. We report a case of 56 years old male with history of renal transplantation and using mycophenolate mofetil, cyclosporine and methylprednisolone as maintenance, admitted due to 3 week fever associated with tenderness and swelling on left shoulder. Upon investigation, a diagnosis of septic bursitis was established. Salmonella enteritidis as the definitive causative agent was revealed. He was treated with meropenem 1g IV three times daily and levofloxacin 500 mg IV once a day for 3 weeks, followed by oral ciprofloxacin 500 mg twice a day for 2 weeks and oral metronidazole 500 mg three times a day for 1 week with a total duration of 5 weeks of antibiotics. On the subsequent follow up there was no recurrence episode of fever and the swelling of the left shoulder subsided, no tenderness noted and the patient has no limitation of range of movement. Since immunocompromised state complicates the management, the duration of therapy may twice longer than the typical management of septic bursitis. Salmonella as etiologic agent should be considered as differential in immunocompromised patient with septic bursitis.

Abstrak :
ABSTRAK
Salmonella as a causative agent in septic bursitis is considered rare. We report a case of 56 years old male with history of renal transplantation and using mycophenolate mofetil, cyclosporine and methylprednisolone as maintenance, admitted due to 3 week fever associated with tenderness and swelling on left shoulder. Upon investigation, a diagnosis of septic bursitis was established. Salmonella enteritidis as the definitive causative agent was revealed. He was treated with meropenem 1g IV three times daily and levofloxacin 500 mg IV once a day for 3 weeks, followed by oral ciprofloxacin 500 mg twice a day for 2 weeks and oral metronidazole 500 mg three times a day for 1 week with a total duration of 5 weeks of antibiotics. On the subsequent follow up there was no recurrence episode of fever and the swelling of the left shoulder subsided, no tenderness noted and the patient has no limitation of range of movement. Since immunocompromised state complicates the management, the duration of therapy may twice longer than the typical management of septic bursitis. Salmonella as etiologic agent should be considered as differential in immunocompromised patient with septic bursitis.

Abstrak :
ABSTRACT
Background. Indonesia has the second highest tuberculosis (TB) prevalance in the world. In this TB endemic country, immunocompromised patients, in particular SLE patients are at increased risk of gaining infection. Therefore, it is crucial to identify the risk factors of TB in SLE patients to help clinicians and patients to prevent occurence of TB. Methods. We conduct a case control study of 24 SLE patients with active TB infection and compare it with 24 age and sex matched SLE controls. Data were collected from Cipto Mangukusumo National Hospital from 2012-2016. SLE diagnosis is based on ACR 2012 criteria and all site of TB were included. Patients with comorbidites (diabetes, HIV, CKD) are excluded. Results. Cumulative steroid dose of 2,115±1,368 mg for the last three months significantly correlate with the occurence of TB (p<0.048). Lupus nephritis and administration of pulse steroid in three months elevate the risk of TB (OR=13, OR=9). High level of ESR (81±39 mm/h) compared to control (42+26 mm/h) is associated with the developement of TB. The proportion of extrapulmonary tuberculosis is 33%. Conclusion. Increasing the awareness and cautiousness of SLE patients with these risk factors, especially in TB endemic countries are important to prevent TB.

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ABSTRACT
Latar Belakang. Indonesia merupakan negara dengan prevalensi tuberkulosis tertinggi kedua di dunia. Dalam negara endemik tuberkulosis ini, pasien dengan imunokompromi secara kususnya pasien SLE mempunyai resiko lebih tinggi untuk terkena infeksi TB. Maka itu, adalah penting untuk mengidentifikasi faktor resiko TB pada pasien SLE untuk membantu klinisi dan pasien guna mencegah Tuberkulosis. Metode. Kami melakukan sebuah studi kasus-kontrol dengan 24 pasien SLE yang mempunyai infeksi TB aktif dan membandingkannya dengan 24 kontrol matching umur dan usia. Data didapatkan dari rumah sakit nasional Cipto Mangukusumo dari 2012-2016. Diagnosis SLE berdasarkan kriteria ACR tahun 2012 dan semua situs infeksi TB diinklusikan. Pasien dengan komorbiditas (diabetes, HIV, CKD) dieksklusi. Hasil. Dosis kumulatif kortikosteroid 2,115±1,368 mg selama tiga bulan terakhir berkorelasi secara signifikan dengan kejadian infeksi TB (p<0.048). Keberadaan lupus nefritis dan administrasi pulse kortikosteroid dalam kurun waktu tiga bulan meningkatkan risiko infeksi TB (OR=14, OR=9). Tingginya kadar LED (81±39 mm/h) dibandingkan dengan kontrol (42+26 mm/h) juga berkontribusi secara positif dalam kejadian infeksi TB. Proposi TB ekstrapulmoner adalah 33%. Kesimpulan. Penting untuk meningkatkan kesadaran dan kewaspadaan terutama pada daerah endemik TB, terhadap pasien SLE dagan faktor risiko diatas upaya mecegah terjadinya TB.

Abstrak :
Background: Infection has been identified as a major cause of death and also morbidity in SLE patients. Studies in SLE patients have shown several risk factors that contribute to fungal infections or infections in general, including the risk of certain pharmacological treatments such as corticosteroids and cytotoxic agents, as well as the effects of intrinsic factors such as CD4 + counts. Methods: A total of 20 medical records of SLE patients with fungal infections were obtained, and a case control study was carried out with age and gender suitable for a control group of 20 patients. Data obtained from the Cipto Mangunkusumo National Hospital. The confirmation diagnosis of SLE was based on the 2012 ACR criteria. Patients with comorbidities of various chronic diseases (diabetes, HIV, CKD) were excluded. In identifying risk factors, Chi-square and Mann-Whitney U-tests were used. Results: The maximum corticosteroid dose of 24 (4-250) mg over the past 1 year was statistically significant with the development of fungal infections (P = 0.047). Lower ALC (748 (99-3312)) compared to the control group (1635 (259-2743)) was also significantly correlated with the occurrence of fungal infections in patients diagnosed with SLE. Conclusion: Identifying predisposing factors in SLE patients is important to prevent the occurrence of serious fungal infections which are one of the main causes of death in SLE patients.

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Latar Belakang: Infeksi telah diketahui sebagai penyebab utama kematian dan juga morbiditas pada pasien SLE. Studi pada pasien SLE telah menunjukkan beberapa faktor risiko yang berkontribusi terhadap infeksi jamur atau infeksi secara umum, termasuk risiko pengobatan farmakologis tertentu seperti kortikosteroid dan agen sitotoksik, serta efek faktor intrinsik seperti jumlah CD4 +. Metode: Total 20 catatan medis pasien SLE dengan infeksi jamur diperoleh, dan studi kasus kontrol dilakukan dengan usia dan jenis kelamin yang cocok untuk kelompok kontrol yang terdiri dari 20 pasien. Data diperoleh dari Rumah Sakit Nasional Cipto Mangunkusumo. Diagnosis konfirmasi SLE didasarkan pada kriteria ACR 2012. Pasien dengan komorbiditas berbagai penyakit kronis (diabetes, HIV, CKD) dikeluarkan. Dalam mengidentifikasi faktor-faktor risiko, Chi-square dan Mann-Whitney U-test digunakan. Hasil: Dosis kortikosteroid maksimum 24 (4 - 250) mg selama 1 tahun terakhir bermakna secara statistik dengan perkembangan infeksi jamur (P = 0,047). ALC yang lebih rendah (748 (99-3312)) dibandingkan dengan kelompok kontrol (1635 (259-2743)) juga secara signifikan berkorelasi dengan terjadinya infeksi jamur pada pasien yang didiagnosis dengan SLE. Kesimpulan: Mengidentifikasi faktor predisposisi pada pasien SLE penting untuk mencegah terjadinya infeksi jamur serius yang merupakan salah satu penyebab utama kematian pada pasien SLE.

Abstrak :
Latar Belakang: Lupus eritematosus sistemik (LES) adalah penyakit autoimun sistemik yang dapat melibatkan berbagai organ dan sistem tubuh. Pasien dengan LES tidak bisa disembuhkan, melainkan dikontrol dengan pendekatan terapi treat-to-target bertujuan mencapai low lupus disease activity state (LLDAS) atau remisi. Pemantauan dilakukan secara berkala setiap 3-6 bulan sekali untuk menghindari kerusakan organ lebih lanjut. Metode: Penelitian analitik observasional dengan desain kohort retrospektif menggunakan data dari rekam medis pasien LES di RSCM. Didapatkan total 66 pasien yang telah berobat selama 6 bulan pada Mei 2021—Juni 2022. Respons yang dilihat yaitu status aktivitas penyakit berdasarkan skor SLEDAI-2K pada bulan pertama dan keenam serta luaran penyakit, meliputi remisi, perbaikan, persisten aktif, dan perburukan. Hasil: Sebagian besar pasien LES adalah perempuan (95,5%), rerata usia 31,23 tahun, dan keterlibatan organ terbanyak muskuloskeletal (93,9%). Hidroksiklorokuin dan metilprednisolon merupakan terapi yang paling banyak didapatkan pasien. Setelah 6 bulan terapi, status aktivitas penyakit pasien membaik dengan luaran penyakit perbaikan (33,3%) dan remisi (10,6%). Kesimpulan: Setelah menjalani pengobatan selama 6 bulan, status aktivitas penyakit pasien membaik dari kategori aktivitas penyakit sedang (37,9%) menjadi ringan (48,5%). Terdapat perbedaan yang bermakna signifikan secara statistik dan klinis antara skor SLEDAI-2K bulan pertama dengan bulan keenam (p = 0,000). ......Introduction: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that involve various organs and body systems. Patients with SLE cannot be cured, but rather controlled with a treat-to-target therapy approach aimed at achieving low lupus disease activity state (LLDAS) or remission. Monitoring is carried out regularly every 3- 6 months to avoid further organ damage. Method: Observational analytical study with retrospective cohort design using database from medical records of SLE patients at RSCM. There were a total of 66 patients who had received treatment for 6 months in May 2021—June 2022. The interests were disease activity based on the SLEDAI-2K score in the first and sixth months as well as disease outcomes, such as remission, improvement, persistently active, and flare. Results: Most SLE patients were women (95.5%), the average age was 31.23 years, and the most organ involvement was musculoskeletal (93.9%). Hydroxychloroquine and methylprednisolone are the most common therapy received by patients. After 6 months of therapy, the overall patient's disease activity status improved with an outcome of improvement (33.3%) and remission (10.6%). Conclusion: After undergoing treatment for 6 months, the patient's disease activity status improved from moderate (37.9%) to mild (48.5%) disease activity category. There was a statistically and clinically significant difference between the SLEDAI-2K score for the first month and the sixth month (p = 0.000).