Faktor risiko dan tatalaksana kandidiasis oral pada pasien dengan drug reaction with eosinophilia and systemic symptoms (DRESS)Risk factors and management of oral candidiasis in drug reaction with eosinophilia and systemic symptoms (DRESS) patients

Abstract

Pendahuluan: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) adalah reaksi obat yang jarang terjadi, tetapi menimbulkan reaksi klinis yang berat, berupa demam, erupsi kulit, dan keterlibatan organ internal. Terapi medikasi untuk pasien DRESS berupa pemberian kortikosteroid high potent memiliki faktor risiko terjadinya kandidiasis oral selain faktor gangguan imunitas secara sistemik akibat DRESS. Penulisan laporan kasus bertujuan untuk memaparkan faktor risiko dan tatalaksana kandidiasis oral pada pasien DRESS. Laporan kasus: Seorang laki-laki berusia 51 tahun dirawat selama 14 hari dengan diagnosis DRESS oleh bagian Dermatologi dan Venereologi Rumah Sakit Hasan Sadikin Bandung. Terapi intravena yang diberikan adalah Deksametason 20 gram/hari, Vitamin K 3x1 ampul/hari, Omeprazole 1x40 gram/hari, dan Siprofloksasin 2x400 gram/hari. Terapi per oral yang diberikan adalah: Cetirizine 1x10 gram/hari, Curcuma 3x1 kapsul/hari, Asam folat 1x1 tab/hari, Asetilsistein 2x2 mg/hari, serta Callos 1x500 mg/hari. Pasien kemudian dikonsulkan ke bagian Ilmu Penyakit Mulut karena memiliki keluhan sakit pada rongga mulut, tenggorokan, dan bibir sejak 3 hari di RS. Riwayat sariawan berulang disangkal. Pasien tidak pernah menyikat gigi selama rawat inap. Tatalaksana kandidiasis oral diberikan Nystatin in oral suspension 4x200.000 IU/hari, Chlorhexidine digluconate 0,12%, asam hialuronat, NaCl 0,9%, serta Mikonazol krim 2% dan racikan deksametason salep 0,002% diberikan terkait lesi pada bibir dan dioleskan pada sudut mulut. Simpulan: Faktor risiko kandidiasis oral pada pasien DRESS adalah penggunaan kortikosteroid secara sistemik, gangguan imun terkait DRESS, dan kebersihan rongga mulut yang buruk. Tatalaksana kandidiasis oral diberikan adalah antifungal dan antiseptik.Kata kunci: drug reaction with eosinophilia and systemic symptoms; faktor risiko; kandidiasis oral ABSTRACTIntroduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare drug reaction but causes severe clinical reactions in the form of fever, skin eruptions, and involvement of internal organs. Medical therapy for DRESS patients in the form of high potent corticosteroids has a risk factor for oral candidiasis and systemic immune disorders. This case report aimed to describe the risk factors and management of oral candidiasis in DRESS patients. Case report: A 51-year-old male was treated for 14 days with a diagnosis of DRESS by the Department of Dermatology and Venereology of Hasan Sadikin Hospital, Bandung. Intravenous therapy administered was 20 grams/day of Dexamethasone, 3x1 ampoules/day of Vitamin K, 1x40 grams/day of Omeprazole, and 2x400 grams/day of Ciprofloxacin. Oral therapy was 1x10 grams/day of Cetirizine, 3x1 capsules/day of Curcuma, 1x1 tab/day of folic acid, 2x2 mg/day of Acetylcysteine, and 1x500 mg/day of Callos. The patient was then referred to the Department of Oral Medicine because of complaints of pain in the oral cavity, throat, and lips after hospitalisation for three days. History of recurrent thrush was denied. The patient never brushed his teeth during hospitalisation. The management of oral candidiasis was the administration of Nystatin in oral suspension with the dose of 4x200,000 IU/day, 0.12% Chlorhexidine digluconate, hyaluronic acid, 0.9% NaCl, and 2% topical Miconazole,  and a mixture of 0.002% dexamethasone ointment, which was given related to lesions on the lips, and topically administered in the corner of the lips. Conclusion: The risk factors for oral candidiasis in DRESS patients are systemic use of corticosteroids, DRESS-related immune disorders, and poor oral hygiene. The management of oral candidiasis is antifungal and antiseptic.Keywords: drug reaction with eosinophilia and systemic symptoms; oral candidiasis, risk factors