PERFORASI SEPTUM NASAL PADA PASIEN DENGAN LUPUS ERITEMATOSUS SISTEMIK YANG AWALNYA DIDUGA MORBUS HANSEN
DOI:
https://doi.org/10.33820/mdvi.v47i4.370Keywords:
LES, CCLE, perforasi septum nasal, morbus hansenAbstract
Morbus Hansen is one of the great imitator skin diseases. The destruction of nasal cartilage, which may lead to nasal septum perforation and saddle nose, can be seen in lepromatous leprosy. Despite its rarity, the acute exacerbation of systemic lupus erythematosus (SLE) can also lead to nasal septum perforation. A 47- year-old female, presented with a 7-year history of prurituc erythematous macules on the scalp, face, chest, back, and both arms. There was also an area of baldness on the scalp. Those lesions enlarged and increased in numbers gradually. There were cicatricial alopecia, moon face, saddle nose, and nasal septum perforation, without any peripheral nerves thickening. Slit skin smear examination revealed no acid-fast bacilli . Anti- nuclear antibody, anti-dsDNA, and anti-nucleosome were reactive. The histopathological findings and direct immunofluorescence result supported the diagnosis of chronic cutaneous lupus erythematosus (CCLE). The patient was advised to avoid excessive sun exposure and apply sunscreen regularly. She was treated with topical corticosteroid, methylprednisolone, chloroquine, and azathioprine. The involvement of nasal mucosa may be ignored and need more attention in assessing patients with SLE.
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References
2. Kar Kumar H, Sharma Pankaj. Leprosy reaction. Dalam: Kar Kumar H, Sharma Pankaj, penyunting. IAL textbook of leprosy. New Delhi: Jaypee Brothers Medical Publishers; 2010. h. 269-87 Gunakan IAL edisi terbaru. Kalau tidak salah edisi ke-2 tahun 2017
3. Swathi M, Rao R, Silvia WD. Evaluation of bone resorption markers in leprosy. Intl J Clin Diag Res. 2014;2:1-9.
4. Kumar WR, Kothari SK, Swamy MKS. Deformities and bony changes in leprosy. IJPMR. 2014;25(1);13-7.
5. Chong BF, Werth VP. Skin Disease in cutaneous lupus erythematosus. Dalam: Wallace DJ, Hahn BH, penyunting. Dubois’s lupus erythematosus. Edisi ke-8. Massachusetts: Lippincott Williams & Wilkins; 2007. h. 319-30
6. Costner MI, Sontheimer RD. Lupus erythematosus. Dalam: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffel DJ, Wolff K, penyunting. Fitzpatrick’s dermatology in general medicine. Edisi ke-8. New York: McGraw-Hill; 2012. h. 1909-26.
7. Aljohani R, Gladman D, Su J, Urowitz M. Disease evolution in late-onset and early-onset systemic lupus erythematosus. Lupus. 2017; 26:1-7.
8. Yazdany J, Dall'Era M. Definition and classification of lupus- related disorders. Dalam: Wallace DJ, Hahn BH, penyunting. Dubois' lupus erythematosus and related syndromes. Edisi ke-8. Philadelphia: Saunders Elsevier; 2013. h. 1-7.
9. Robson AK, Burge SM, Millard PR. Nasal mucosal involvement in lupus erythematosus. Clin Otolaryngol. 1992;17:341-3.
10. Snyder GG, McCarthy RE, Toomey JM, Rothfield NF. Nasal septal perforation in systemic lupus erythematosus. Arch Otolaryngol. 1974;99:456-7.
11. Burge SM, Frith PA, Juniper RP, Wojnarowska J. Mucosal involvement in systemic and chronic cutaneous lupus erythematosus. Br J Dermatol. 1989;121:727-41.
12. Bruno E, Russo S, Nucci R, Alessandrini M, Di Girolamo S. Nasal mucosal involvement in systemic lupus erythematosus: histopatologic and immunopathologic study. Int J Immunopathol Pharmacol. 2000;13:39-42.
13. Sticherling M. Lupus erythematosus: chronic cutaneous lupus erythematosus. Dalam: Hertl M, penyunting. Autoimmune disease of the skin. Edisi ke-2. New York: Springer; 2005. h. 193-213.
14. Crowson AN, Magro C. The cutaneous pathology of lupus erythematosus: a review. J Cutan Pathol. 2001;28:1–23.

15. Kuhn A, Landmann A. The classification and diagnosis of cutaneous lupus erythematosus. J Autoimmun. 2014;48:14-9. 16. Al-Saif FM, Al-Balbeesi AO, Al-Samary AI, Al-Rashid SB, Halwani M. Discoid lupus erythematosus in a Saudi population: clinical and histopathological study. J Saudi Soc
Dermatol. 2012;16:9-12.
17. Luger TA, Bonsmann G, Kuhn A, Bohm M. Cutaneous
lupus erythematosus. Dalam: Tsokos GC, Gordon C, Smolen JS, penyunting. Systemic lupus erythematosus, Edisi ke-1. Phildelphia: Mosby; 2007. h. 351-60.
18. Vermeersch P, Bossuyt X. Prevalence and clinical significance of rare antinuclear antibody patterns. Autoimmun Rev. 2013;12:998-1003
19. Bonsmann G, Schiller M, Luger TA, Stunder S. Terbinafine- induced subacute cutane ous lupus erythematosus. J Am Acad Dermatol. 2001;44:925-31. 

20. Okon LG, Werth VP. Cutaneous lupus erythematosus: Diagnosis and treatment. Best Pract Res Clin Rheumatol 2013;27:391- 404.
21. Thelma Skare T, Ribeiro CF, Souza FH. Antimalarial cutaneous side effects: a study in 209 users. Cutan Ocul Toxicol. 2011;30:45–9.