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Postinflammatory Hyperpigmentatio n + Candidiasis oral

IN Hiv PATIENT

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MEMBER OF GROUP :

Ridwan Fajiri 110.207.019 Fitriani Syamsul 110.207.066

PATIENT IDENTITY
Name Gender Age Marital

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: Mr. A : Male : 29 years old status : Single : Muslim : Guard : Adipura 2 B2/18 date : 06/09/2012

Religion Occupation Address Addmission

History Taking
Chief Brief

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Complaint: watery stool

anemnesis: since a day ago, frec. 10/day. mucous (-), blood (-). History watery stool (+) since 2 years back. Febris since a day ago, intermittent, and decrease with medicine. Swering (-), Headache (-),cough (+) since 1 week, mocous (-), chest pain (-), nause (+), vomitting (+) frec. 3 x a day. loss of appetite since 1 year ago with decrease of body weight.

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Medical history : TB treatment (+) since 1 year IV drug consumption (-) Alkohol comsumption (-)

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CURRENT STATUS
Consciousness General Hygiene Nutrition Vital

: Compos Mentis : Moderate

Condition : Moderate : Less : 100/60 mmHg : 80x/minutes : 20/minutes : 37,50C

sign

BP Pulse RR

Temperature

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PHYSICAL EXAMINATION
Anemic

(-), icterus (-), cyanoses

(-)
Cor/

Pulmonal: Normal Normal, peristaltic (+) Edema (-)

Abdomen:

Extremities: Lymph

nodes: Enlargement (-)

DERMATOVENEROLOGY STATUS
Regio:

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Facialis all of face

Efloresensi: Hyperpigmentation Squama

in eyeshadow, around the mouth, beard, and ears Regio : Auricular dextra o Efloresensi : Squama
o

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Laboratory Result
Ureum Creatine SGOT SGPT WBC RBC HB HCT PLT

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: 4 mg/dl (N= 10 - 50 mg/dL) : 0,92 mg/dl : 219 U/I : 77 U/I : 1.6 x 10 3 /uL : 2,92 x 10 6 /uL : 7,4 (g/dL) : 22,2 % : 63x10 3 /uL

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Ureum Creatine GDP

: 4 mg/dl (N= 10 - 50 mg/dL) : 0,92 mg/dl (N= 0,6 - 1,1 mg/dL)

: 86 mg/dl (N= <126 mg/dL) 77 U/I : 219 U/I

SGOT : SGPT

RESUME
Brief

anemnesis: Mr.A came to hospital with atery stool since a day ago, frec. 10/day. History watery stool (+) since 2 years back. Febris since a day ago, intermittent, and decrease with medicine. cough (+) since 1 week, nause (+), vomitting (+) frec. 3 x a day. loss of appetite since 1 year ago with decrease of body weight. Medical history : TB treatment (+) since 1 year

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Dermato-venerology

Regio: Reg.Facial Efl. : Squama macula hyperpigmentation all of face

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DIAGNOSIS

Postinflammator y Hyperpigmentati on + Susp.Seboroic

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Diferensial Diagosis
q Tinea

Facialis

q Melasma

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Suggestion Examination
Mycologic examination :
10-15% From

KOH preparation

Skin scraping culture on Saborauds agar media

Fungal

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Therapy
Hidrocortison Laolin

10 gr

5 gr add 30 gr

Vaselin TCA

(Tricloroasetat)

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Prognosis
Altough often experience residif, the prognosis is good (Bonam)

DISCUSSION

Postinflammatory hyperpigmentattion (PIH) is a common disorder affecting individuals with skin of color. PIH present with tan, brown, or gray macules or patches occuring at the slite of a previous inflammatory stimulus. Some other have concluded that people with skin of color are more likely to develop PIH owing to the large amount of melanin contained in melanosomes whitin the epidermis

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The incubation period after exposure ranges from three weeks to eight months. Most infections are transient and cleared within two years. Persistent infections in the setting of other clinical risk factors (such as infection with the human immunodeficiency virus) are associated with the development of squamous cell carcinoma.

Condyloma acuminatum is related to sexual activity. Digital/anal, oral/anal and digital/vaginal contact probably can also spread the virus, as may fomite. The disease is also more common in immunosuppressed individuals.

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SIGNS AND SYMPTOMS

Genital lession are flat or dome-shaped, and can be pink, red, or brown in color. Patient may be attached to their skin with a thin stem. Lession may be small at first, and then grow larger. Patient may have one or more lession, which can group together. Over time the lession may look like a cauliflower. Genital lession may feel moist and rough when it touched. As the lession grow, the skin area may itch or burn. If the lession grow together, they may be painful. If the lession grow in size or the patient get more of them, they may have problems urinating or having a bowel movement.

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KONDILOMA AKUMINATA IN HIV PATIENT

The progress of Kondiloma akuminatum in HIV patient is faster to become carcinoma cerviks and carcinoma cell skuamous.

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Kondiloma akuminata

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Kondiloma akuminatum in penis and anal

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DIAGNOSED
We may need any of the following tests:
Acetic Biopsy Pap

acid test

smear

Colposcopy

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TREATMENT & MANAGEMENT

Medicines 1. 2. 3.

Immunomodulators Antiproliferatives Anivirals Procedurs Cryotherapy Electrocautery Excision Laser

. 1. 2. 3. 4.

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PROGNOSIS
Good

(Bonam)

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Wassalam

Thank You