CASE REPORT
LAPORAN TIGA KASUS TUBERKULOSIS EKSTRA PARU
Dewi Resnawita, Marlina Rays, Harun Iskandar, Eliana Muis, Muhammad Ilyas, Nur Ahmad Tabri, Irawati Djaharuddin, Erwin Arief, A. Makbul Aman, Syakib Bakri
'HSDUWHPHQ,OPX3HQ\DNLW'DODP)DNXOWDV.HGRNWHUDQ8QLYHUVLWDV+DVDQXGGLQ
ABSTRAK
7XEHUNXORVLV 7% PHUXSDNDQ SHQ\DNLW LQIHNVLXV \DQJ GDSDW PHQJDQFDP Q\DZD GHQJDQ DQJND LQVLGHQVL\DQJWLQJJLGLGXQLDWHUXWDPDGLQHJDUDQHJDUDEHUNHPEDQJVHSHUWL,QGRQHVLD0HVNLSXQ VHEDJLDQEHVDUNDVXV7%GLWHPXNDQSDGDSDUXSDUXSURSRUVLSDVLHQ\DQJPHQJDODPLLQIHNVL7% HNVWUDSDUXMXJDPHQXQMXNNDQDQJND\DQJVLJQL¿NDQ%HULNXWGLODSRUNDQWLJDNDVXV7%HNVWUDSDUX .DVXVSHUWDPDZDQLWDWDKXQGHQJDQJDPEDUDQNOLQLVEHQMRODQSDGDGDHUDKPXOXW\DQJDZDOQ\D GLSHUNLUDNDQ PHQGHULWD WXPRU NHPXGLDQ GLODNXNDQ SHPHULNVDDQ KLVWRSDWRORJLV GLSHUROHK KDVLO SHUDGDQJDQNURQLNJUDQXORPDWRXV.DVXVNHGXDZDQLWDWDKXQGHQJDQJDPEDUDQNOLQLVEHUXSD SODNKLSHUNHUDWRVLVHULWHPDGDQVNXDPDUHJLRLQWHUSKDODQJGLJLWL dua dextra kemudian dilakukan
SHPHULNVDDQKLVWRSDWRORJLVGLSHUROHKKDVLO7XEHUNXORVLVNXWLVYHUXNRVD.DVXVNHWLJDODNLODNL WDKXQGHQJDQQ\HULGDQEHQJNDNSDGDOXWXWNDQDQNHPXGLDQGLODNXNDQSHPHULNVDDQKLVWRSDWRORJLV GLSHUROHKKDVLOUDGDQJNURQLNJUDQXORPDWRVDVXSXUDWLI7HUKDGDSNHWLJDSDVLHQLQLGLEHULNDQREDW DQWLWXEHUNXORVLV2$7NDWHJRUL,+5=(+5GDQWHUMDGLSHUEDLNDQNOLQLV
Kata kunci:7%HNVWUDSDUXREDWDQWLWXEHUNXORVLV
Address for corespondance :
(PDLO'HZL5HVQDZLWD#JPDLOFRP 0DUOLQD5D\V#JPDLOFRP +RZ7R&LWH7KLV$UWLFOH
LAPORAN TIGA KASUS TUBERKULOSIS EKSTRA PARU PENDAHULUAN
7XEHUNXORVLV 7% PHUXSDNDQ SHQ\DNLW LQIHNVLXV \DQJ GDSDW PHQJDQFDP Q\DZD GHQJDQ DQJND LQVLGHQVL \DQJ WLQJJL GL GXQLD WHUXWDPD GL QHJDUDQHJDUD EHUNHPEDQJ VHSHUWL ,QGRQHVLD0HVNLSXQVHEDJLDQEHVDUNDVXV7% GLWHPXNDQ SDGD SDUXSDUX SURSRUVL SDVLHQ \DQJ PHQJDODPL LQIHNVL 7% HNVWUD SDUX MXJD PHQXQMXNNDQDQJND\DQJVLJQL¿NDQ2UJDQLVDVL .HVHKDWDQ'XQLDWorld Health Organization
:+2 PHQGH¿QLVLNDQ 7% HNVWUD SDUX ([WUDSXOPRQDU\ 7% (37% VHEDJDL µVHRUDQJ SDVLHQ GHQJDQ WXEHUNXORVLV SDGD RUJDQ VHODLQ SDUX PLVDOQ\D SOHXUD NHOHQMDU JHWDK EHQLQJ DEGRPHQ WUDNWXV XURJHQLWDOLD NXOLW WXODQJ GDQVHQGLVHUWDPHQLQJHV¶+DPSLUVHSHUOLPD NDVXV7%GL$PHULND6HULNDWDGDODK(37%'L QHJDUDEHUNHPEDQJVHNLWDUGDULSHQGHULWD 7% PHUXSDNDQ SHQGHULWD (37% %HQWXN (37% PDVLK PHUXSDNDQ PDVDODK NHVHKDWDQ PDV\DUDNDW \DQJ EHVDU NDUHQD PDVLK VXOLW WHUGLDJQRVLV GLPDQD PHPHUOXNDQ SHPHULNVDDQ SHQXQMDQJ\DQJKDUXVPHPDGDL
7%SDODWXPPHUXSDNDQ7%SDGDDUHDRUDO \DQJ PDVLK GLDQJJDS ODQJND 3HQWLQJ XQWXN PHQJHQDOL NRQGLVL LQL NDUHQD KDO WHUVHEXW
DNDQ PHQHQWXNDQ SHQHJDNDQ GLDJQRVLV GDQ SHQDWDODNVDQDDQ DZDO PHQJLQJDW NRQGLVL LQL GDSDW GLVDODKDUWLNDQ VHEDJDL QHRSODVPD DWDX XONXV WUDXPDWLF VHKLQJJD SHQHJDNDQ GLDJQRVLVSXQ PHQMDGL WHUODPEDW .DNLVL HW
al. PHQLQMDX NHPEDOL OLWHUDWXU ,QJJULV GDQ
PHQHPXNDQNDVXV7%GHQJDQPDQLIHVWDVL RUDO 'DODP UHYLVL LQL XVLD UDWDUDWD SDVLHQ DGDODKWDKXQGLPDQDSDVLHQDGDODK DQDNDQDN +DQ\D NDVXV \DQJ GLWHPXNDQ
pada palatum durum atau palatum molle.
7XEHUNXORVLV NXWLV YHUXNRVD DGDODK JDQJJXDQ SDXVLEDVLOHU \DQJ GLVHEDENDQ ROHK UHLQIHNVL HNVRJHQ LQRNXODVL VHWHODK DGDQ\D VHQVLWLVDVL GHQJDQ LPXQLWDV \DQJ WLQJJL 7XEHUNXORVLV NXWLV PHQMDGL PDVDODK NHVHKDWDQ
NDVXV7%NXWLVGDODPSHQHOLWLDQPHUHNDVHODPD WDKXQ GL +RQJ .RQJ %HEHUDSD ODSRUDQ PHQXQMXNNDQEDKZD7%NXWLVPHZDNLOLVHNLWDU GDUL VHPXD NDVXV GHUPDWRORJL GLOLKDW GL NOLQLNUDZDWMDODQ
7XEHUNXORVLV SDGD VHQGL OXWXW GLNHQDO MXJDVHEDJDLJRQLWLVWXEHUNXORVLV7XEHUNXORVLV WXODQJGDQVHQGLSDOLQJVHULQJPHQ\HUDQJVHQGL SHQRSDQJEHUDWEDGDQVHNLWDUSDGDWXODQJ EHODNDQJ SDGD SLQJJXO GDQ VHNLWDU SDGD OXWXW *RQLWLV WXEHUNXORVLV PHUXSDNDQ WXEHUNXORVLVSDGDWXODQJGDQVHQGL\DQJSDOLQJ MDUDQJGLWHPXNDQ
LAPORAN KASUS I
1\ 0 WDKXQ LEX UXPDK WDQJJD 50 PHQJXQMXQJL SROL SDUX 5XPDK 6DNLW :DKLGLQ 6XGLURKXVRGR \DQJ VHEHOXPQ\D GLNRQVXO GDUL SROL 7+7 GHQJDQ 7% SDODWXP .HOXKDQ XWDPD EHQMRODQ SDGD PXOXW GLDODPL VHMDN VDWX EXODQ WHUDNKLU WLGDN VHPDNLQ PHPEHVDU WLGDN Q\HUL WLGDN PXGDK EHUGDUDK WHWDSL PHQJDQJJX SDVLHQ GDODP PDNDQ GDQ PLQXP $ZDOQ\D SDVLHQ PHQJDWDNDQ EHQMRODQ
mulai dirasakan tumbuh setelah pasien menyikat
JLJLGDQPHPEHQWXUODQJLWODQJLWPXOXW3DVLHQ
tidak ada demam saat ini maupun riwayat demam
VHEHOXPQ\D%DWXNVHVDNQDSDVPDXSXQQ\HUL GDGD WLGDN DGD 0XDO PXQWDK Q\HUL XOX KDWL WLGDNDGD1DIVXPDNDQPHQXUXQDGD.HULQJDW PDODP WLGDN DGD %HUDW EDGDQ PHQXUXQ DGD NJ GDODP EXODQ WHUDNKLU %XDQJ DLU NHFLO ODQFDUEHUZDUQDNXQLQJMHUQLKWLGDNDGDGDUDK %XDQJDLUEHVDUELDVDWLGDNDGDGDUDK5LZD\DW
7%GLVDQJNDO5LZD\DWNRQWDNGHQJDQSHQGHULWD 7% GLVDQJNDO 5LZD\DW +LSHUWHQVL GLVDQJNDO 5LZD\DW 'LDEHWHV 0HOLWXV GLVDQJNDO 5LZD\DW PHURNRN WLGDN DGD 5LZD\DW NRQVXPVL REDW REDWDQWLGDNDGD5LZD\DWDOHUJLWLGDNDGD
3DGD SHPHULNVDDQ ¿VLN GLGDSDWNDQ SHQGHULWD VDGDU WDPSDN VDNLW VHGDQJ JL]L NXUDQJ7DQGD YLWDO GDODP EDWDV QRUPDO 3DGD
FDYXP RULV tampak lesi eritematous ukuran
Gambar 1. Klinis saat pertama kali datang
Gambar 2. Foto toraks
NDVXV7%NXWLVGDODPSHQHOLWLDQPHUHNDVHODPD WDKXQ GL +RQJ .RQJ %HEHUDSD ODSRUDQ PHQXQMXNNDQEDKZD7%NXWLVPHZDNLOLVHNLWDU GDUL VHPXD NDVXV GHUPDWRORJL GLOLKDW GL NOLQLNUDZDWMDODQ
7XEHUNXORVLV SDGD VHQGL OXWXW GLNHQDO MXJDVHEDJDLJRQLWLVWXEHUNXORVLV7XEHUNXORVLV WXODQJGDQVHQGLSDOLQJVHULQJPHQ\HUDQJVHQGL SHQRSDQJEHUDWEDGDQVHNLWDUSDGDWXODQJ EHODNDQJ SDGD SLQJJXO GDQ VHNLWDU SDGD OXWXW *RQLWLV WXEHUNXORVLV PHUXSDNDQ WXEHUNXORVLVSDGDWXODQJGDQVHQGL\DQJSDOLQJ MDUDQJGLWHPXNDQ
1\ 0 WDKXQ LEX UXPDK WDQJJD 50 PHQJXQMXQJL SROL SDUX 5XPDK 6DNLW :DKLGLQ 6XGLURKXVRGR \DQJ VHEHOXPQ\D GLNRQVXO GDUL SROL 7+7 GHQJDQ 7% SDODWXP .HOXKDQ XWDPD EHQMRODQ SDGD PXOXW GLDODPL VHMDN VDWX EXODQ WHUDNKLU WLGDN VHPDNLQ PHPEHVDU WLGDN Q\HUL WLGDN PXGDK EHUGDUDK WHWDSL PHQJDQJJX SDVLHQ GDODP PDNDQ GDQ PLQXP $ZDOQ\D SDVLHQ PHQJDWDNDQ EHQMRODQ
JLJLGDQPHPEHQWXUODQJLWODQJLWPXOXW3DVLHQ
VHEHOXPQ\D%DWXNVHVDNQDSDVPDXSXQQ\HUL GDGD WLGDN DGD 0XDO PXQWDK Q\HUL XOX KDWL WLGDNDGD1DIVXPDNDQPHQXUXQDGD.HULQJDW PDODP WLGDN DGD %HUDW EDGDQ PHQXUXQ DGD NJ GDODP EXODQ WHUDNKLU %XDQJ DLU NHFLO ODQFDUEHUZDUQDNXQLQJMHUQLKWLGDNDGDGDUDK %XDQJDLUEHVDUELDVDWLGDNDGDGDUDK5LZD\DW
7%GLVDQJNDO5LZD\DWNRQWDNGHQJDQSHQGHULWD 7% GLVDQJNDO 5LZD\DW +LSHUWHQVL GLVDQJNDO 5LZD\DW 'LDEHWHV 0HOLWXV GLVDQJNDO 5LZD\DW PHURNRN WLGDN DGD 5LZD\DW NRQVXPVL REDW REDWDQWLGDNDGD5LZD\DWDOHUJLWLGDNDGD
3DGD SHPHULNVDDQ ¿VLN GLGDSDWNDQ SHQGHULWD VDGDU WDPSDN VDNLW VHGDQJ JL]L NXUDQJ7DQGD YLWDO GDODP EDWDV QRUPDO 3DGD
FDYXP RULV
[FP SDGDSDODWXP PROOH WLGDN DGD GDUDK SHUPXNDDQ JUDQXOHU Q\HUL WHNDQ WLGDN DGD 3HPHULNVDDQSDUXGDODPEDWDVQRUPDO
Hasil &76FDQNHSDODPDVVDSDODWXP\DQJ
PHOXDV NH VLQXV PD[LOODULV GDQ PHQGHVWUXNVL WXODQJ VHNLWDUQ\D )RWR WRUDNV GDODP EDWDV QRUPDO 6SXWXP EDVLO WDKDQ DVDP %7$ [ QHJDWLIQHJDWLIQHJDWLI+DVLO3DWRORJL$QDWRPL GDULRUJDQSDODWXPGLGDSDWNDQVHGLDDQMDULQJDQ GLODSLVL HSLWHO VNXDPRVD EHUODSLV GLEDZDKQ\D WHUGDSDW EDQ\DN JUDQXORPDHSLWKHORLGGHQJDQ VHQWUDOQHNURVLVEDQ\DNVHOGDWLDODQJKDQVGDQ VHOVHOOLPIRVLWGHQJDQNHVDQSHUDGDQJDQNURQLN JUDQXORPDWRXV\DQJVHVXDLXQWXNSURVHVVSHVL¿N 7%
%HUGDVDUNDQDQDPQHVLVSHPHULNVDDQ¿VLN GDQ SHPHULNVDDQ SHQXQMDQJ PDND GLDJQRVLV
pasien ini adalah tuberkulosis pada palatum.
3HQDQJDQDQ SDGD SDVLHQ LQL 2$7 NDWHJRUL +5=(+5 VHODPD EXODQ \DQJ GDSDW GLSHUSDQMDQJ VDPSDL EXODQ 6HWHODK PHQGDSDWNDQWHUDSLVHODPDWLJDEXODQNRQGLVL
pasien semakin membaik.
LAPORAN KASUS 2
1\0 WDKXQ LEX UXPDK WDQJJD PHQJXQMXQJLSROLSDUX56:DKLGLQ6XGLURKXVRGR \DQJVHEHOXPQ\DGLNRQVXOGDULSROLNXOLWGHQJDQ NHOXKDQEHUFDNPHQHEDOGLMDULWHOXQMXNNDQDQ .HOXKDQGLUDVDNDQVHMDNHQDPEXODQ\DQJODOX $ZDOQ\DKDQ\DEHUXSDELQWLNNHFLOPHUDK\DQJ VHPDNLQ ODPD PHOHEDU GDQ PHQHEDO 7HUDVD JDWDOGDQWLGDNQ\HUL5LZD\DWEHUREDWGLGRNWHU
spesialis namun tidak ada perbaikan. Demam
GDQULZD\DWGHPDPVHEHOXPQ\DWLGDNDGD6HVDN QDSDV EDWXN GDQ Q\HUL GDGD WLGDN DGD 0XDO PXQWDK GDQ Q\HUL XOX KDWL WLGDN DGD 1DIVX PDNDQ EDLN %HUDW EDGDQ PHQXUXQ GLVDQJNDO .HULQJDWPDODPGLVDQJNDO%XDQJDLUNHFLOODQFDU EHUZDUQDNXQLQJMHUQLKWLGDNDGDGDUDK%XDQJ DLUEHVDUELDVDWLGDNDGDGDUDK5LZD\DWDOHUJL REDWGDQPDNDQDQGLVDQJNDO5LZD\DWSHQ\DNLW ODLQ GLVDQJNDO 5LZD\DW PHQGHULWD EDWXN ODPD GLVDQJNDO5LZD\DWNRQWDNGHQJDQSHQGHULWD7% GLVDQJNDO 5LZD\DW NHOXDUJD GHQJDQ NHOXKDQ \DQJVDPDGLVDQJNDO
3DGD SHPHULNVDDQ ¿VLN GLGDSDWNDQ SDVLHQ VDGDUGHQJDQVDNLWULQJDQGDQJL]LFXNXS7DQGD YLWDO GDODP EDWDV QRUPDO 3DGD SHPHULNVDDQ GHUPDWRORJLV UHJLR LQWHUSKDODQJ GLJLWL dua dextra GLGDSDWNDQ HIÀRUHVHQVL EHUXSD SODN
KLSHUNHUDWRVLVHULWHPD GDQ VNXDPD 7LGDN WDPSDNDGDQ\DSHPEHVDUDQNHOHQMDU
3HPHULNVDDQ ODERUDWRULXP GDODP EDWDV
normal. Foto polos toraks dalam batas normal.
6SXWXP %7$ [ QHJDWLIQHJDWLIQHJDWLI 'LODNXNDQ SHPHULNVDDQ SHQXQMDQJ EHUXSD ELRSVL NXOLW GHQJDQ KDVLO VHGLDDQ MDULQJDQ GLODSLVL HSLGHUPLV \DQJ WDPSDN KLSHUSODVLD SVHXGRHSLWHOLRPVWRXVKLSHUNHUDWRVLVDNDQWRVLV GDODP GHUPLV WHUGDSDW JUDQXORPD HSLWHORLG GHQJDQEHEHUDSDVHOGDWLDODQJKDQVGDQEDQ\DN VHOOLPIRVLW\DQJPHQJHOLOLQJLJUDQXORPDWLGDN WDPSDN DGDQ\D VWUXNWXU MDPXU SDGD VHGLDDQ
kesimpulan tuberculosis kutis verukosa. A
LAPORAN KASUS 3
7Q('WDKXQVHRUDQJQHOD\DQ3DVLHQ PHQJHOXKNDQ Q\HUL SDGD OXWXW NDQDQ GLDODPL VHMDNEXODQPHPEHUDWVHMDNPLQJJXWHUDNKLU Q\HULGLUDVDNDQWHUXVPHQHUXVQ\HULPHPEHUDW MLNDOXWXWGLJHUDNNDQVHKLQJJDSDVLHQNHVXOLWDQ
untuk meluruskan lutut kanannya. Awalnya
SDVLHQPDVLKGDSDWEHUMDODQWHWDSLODPDNHODPDDQ Q\HULVHPDNLQPHPEHUDWVHKLQJJDSDVLHQWLGDN GDSDW EHUMDODQ GDQ KDQ\D ELVD GXGXN VHUWD EHUEDULQJ VHKLQJJD NDNL NLUL WHUOLKDW PHQJHFLO GLEDQGLQJNDQGHQJDQNDNLNDQDQ%HQJNDNSDGD OXWXW NDQDQ GLDODPL VHMDN EXODQ \DQJ ODOX VHPDNLQ ODPD VHPDNLQ PHPEHVDU PHPEHUDW VHMDNEXODQWHUDNKLUEHQJNDNGLUDVDNDQKLQJJD NHNDNL'DHUDKVHNLWDUOXWXWWHUDEDOXQDNWLGDN
nyeri pada penekanan dan tidak kemerahan.
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
menderita penyakit autoimun tidak ada.
3DGD SHPHULNVDDQ ¿VLN GLWHPXNDQ SDVLHQ VDGDU WDPSDN VDNLW VHGDQJ GDQ JL]L NXUDQJ 7HUDEDPDVVDUHJLRJHQXGH[WUDXNXUDQ[ FPWHUDEDOXQDNSDGDSDOSDVLHGHPDSUHWLELDO KLQJJD GRUVXP SHGLV DGD GLVHUWDL Q\HUL GDQ OLQJNXS JHUDN WHUEDWDV WLGDN GLWHPXNDQ SHPEHVDUDQ NHOHQMDU JHWDK EHQLQJ 7HUGDSDW DWUR¿RWRWSDGDWXQJNDLNLUL
3DGD SHPHULNVDDQ IRWR JHQX SRVLVL
anterior-posterior dan lateral didapatkan tampak destruksi pada distal femur dan SUR[LPDOWLELD tidak tampak SHULRVWHDO UHDFWLRQ WDPSDNVRIW
WLVVXH VZHOOLQJ GL JHQX dextra 3HQHULNVDDQ
06&7scan JHQX WDQSD NRQWUDV PHQXQMXNNDQ
PXOWLSHO OHVL OLWLN GLVHUWDL GHVWUXNVL \DQJ PHOLEDWNDQGLVWDOIHPXUSURNVLPDOWLELD¿EXOD GDQSDWHODGH[WUDVHVXDLJDPEDUDQRVWHRP\HOLWLV 'DUL DQDPQHVLV SHPHULNVDDQ ¿VLN
GDQ SHPHULNVDDQ SHQXQMDQJ GLWHJDNNDQ GLDJQRVLV 7XEHUFXORVVL NXWLV YHUXNRVD 7HUDSL \DQJ GLEHULNDQ DGDODK 2$7 NDWHJRUL , +5=(+5
Gambar 7. Foto hasil pemeriksaan histopatologi A. Granuloma epiteloid dan limfosit yang mengelilingi B. Hiperplasia pseudoeritomatous C. Sel Datia langhans
A B
C
Gambar 8. 14 hari post terapi bulan pertama. Tampak penebalan dan skuama sedikit berkurang
7Q('WDKXQVHRUDQJQHOD\DQ3DVLHQ PHQJHOXKNDQ Q\HUL SDGD OXWXW NDQDQ GLDODPL VHMDNEXODQPHPEHUDWVHMDNPLQJJXWHUDNKLU Q\HULGLUDVDNDQWHUXVPHQHUXVQ\HULPHPEHUDW MLNDOXWXWGLJHUDNNDQVHKLQJJDSDVLHQNHVXOLWDQ
SDVLHQPDVLKGDSDWEHUMDODQWHWDSLODPDNHODPDDQ Q\HULVHPDNLQPHPEHUDWVHKLQJJDSDVLHQWLGDN GDSDW EHUMDODQ GDQ KDQ\D ELVD GXGXN VHUWD EHUEDULQJ VHKLQJJD NDNL NLUL WHUOLKDW PHQJHFLO GLEDQGLQJNDQGHQJDQNDNLNDQDQ%HQJNDNSDGD OXWXW NDQDQ GLDODPL VHMDN EXODQ \DQJ ODOX VHPDNLQ ODPD VHPDNLQ PHPEHVDU PHPEHUDW VHMDNEXODQWHUDNKLUEHQJNDNGLUDVDNDQKLQJJD NHNDNL'DHUDKVHNLWDUOXWXWWHUDEDOXQDNWLGDN
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
3DGD SHPHULNVDDQ ¿VLN GLWHPXNDQ SDVLHQ VDGDU WDPSDN VDNLW VHGDQJ GDQ JL]L NXUDQJ 7HUDEDPDVVDUHJLRJHQXGH[WUDXNXUDQ[ FPWHUDEDOXQDNSDGDSDOSDVLHGHPDSUHWLELDO KLQJJD GRUVXP SHGLV DGD GLVHUWDL Q\HUL GDQ OLQJNXS JHUDN WHUEDWDV WLGDN GLWHPXNDQ SHPEHVDUDQ NHOHQMDU JHWDK EHQLQJ 7HUGDSDW DWUR¿RWRWSDGDWXQJNDLNLUL
3DGD SHPHULNVDDQ IRWR JHQX SRVLVL
SUR[LPDOWLELD
SHULRVWHDO UHDFWLRQ WDPSDNVRIW
WLVVXH VZHOOLQJ GL JHQX 3HQHULNVDDQ
06&7 JHQX WDQSD NRQWUDV PHQXQMXNNDQ PXOWLSHO OHVL OLWLN GLVHUWDL GHVWUXNVL \DQJ PHOLEDWNDQGLVWDOIHPXUSURNVLPDOWLELD¿EXOD GDQSDWHODGH[WUDVHVXDLJDPEDUDQRVWHRP\HOLWLV 'DUL DQDPQHVLV SHPHULNVDDQ ¿VLN
GDQ SHPHULNVDDQ SHQXQMDQJ GLWHJDNNDQ GLDJQRVLV 7XEHUFXORVVL NXWLV YHUXNRVD 7HUDSL \DQJ GLEHULNDQ DGDODK 2$7 NDWHJRUL , +5=(+5
3HPHULNVDDQ¿QH QHHGOH DVSLUDWLRQ pada lutut
NDQDQNHVDQVXDWXUHDNVLUDGDQJNURQLN DUWKWURWRP\3DVLHQGLODNXNDQRSHUDVL GLWHPXNDQnecrosis caseosa pada GHEULGHPHQW dan
NQHH MRLQW disertai destruksi dari NQHH MRLQW
DQWHULRU FUXFLDWH OLJDPHQW SRVWHULRU FUXFLDWH OLJDPHQWPHQLVFXVPHGLDOFROODWHUDOOLJDPHQW ODWHUDO FROODWHUDO OLJDPHQW VXEFKRQGUDO ERQH IHPXU 'LODNXNDQ SHPHULNVDDQ KLVWRSDWRORJLV GHQJDQ KDVLO WHUGLUL GDUL IRNXVIRNXV VHQWUDO QHNURWLN \DQJ GLNHOLOLQJL VHOVHO UDGDQJ 301
SRO\PRUSKRQXFOHDUGDQOLPIRVLW3DGDEDJLDQ
perifer tampak sel-sel berinti VSLQGOHLQWLOHELK
EHVDUVHGLNLWDWLSLNGDQKLSHUNURPDWLNGHQJDQ VLWRSODVPD \DQJ FXNXS 7DPSDN VHEDUDQ VHO VHOGDWLDEHULQWLOHELKGDULVDWXPXOWLQXFOHDWHG
giant cell.HVDQUDGDQJNURQLNJUDQXORPDWRVD supuratif.
Gambar 10. Foto klinis
Gambar 11. Foto genu dextra
Gambar 12. Foto polos toraks
Gambar 13. Pemeriksaan MSCT scan genu tanpa kontras
Gambar 14 A. Penampilan mikroskopis granuloma dan nekrosis kaseosa serta penampilan pink yang tajam. Tampak beberapa sel raksasa tipe Langhans B. Detail sel raksasa Langhans dengan lingkaran nukleus
SHULIHU VHSHUWL WDSDO NXGD GDQ VLWRSODVPD HRVLQR¿OLN
yang melimpah dikelilingi oleh histiosit epitelioid yang menyatu membentuk sel raksasa
A B
%HUGDVDUNDQ JHMDOD NOLQLV VHUWD KDVLO SHPHULNVDDQ SHQXQMDQJ SDVLHQ GLGLDJQRVLVVHEDJDL *RQLWLV 7XEHUNXORVLV 'H[WUD GLEHULNDQ WHUDSL 2$7 NDWHJRUL , +5=(+5
DISKUSI
0 WXEHUFXORVLV masuk ke dalam tubuh
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