LAPORAN TIGA KASUS TUBERKULOSIS EKSTRA PARU

  

CASE REPORT

LAPORAN TIGA KASUS TUBERKULOSIS EKSTRA PARU

_{Nur Ahmad Tabri, Irawati Djaharuddin, Erwin Arief, A. Makbul Aman, Syakib Bakri}

_{Dewi Resnawita, Marlina Rays, Harun Iskandar, Eliana Muis, Muhammad Ilyas,}

'HSDUWHPHQ ,OPX 3HQ\DNLW 'DODP )DNXOWDV .HGRNWHUDQ 8QLYHUVLWDV +DVDQXGGLQ

  ABSTRAK

  7XEHUNXORVLV 7% PHUXSDNDQ SHQ\DNLW LQIHNVLXV \DQJ GDSDW PHQJDQFDP Q\DZD GHQJDQ DQJND LQVLGHQVL \DQJ WLQJJL GL GXQLD WHUXWDPD GL QHJDUD QHJDUD EHUNHPEDQJ VHSHUWL ,QGRQHVLD 0HVNLSXQ

  VHEDJLDQ EHVDU NDVXV 7% GLWHPXNDQ SDGD SDUX SDUX SURSRUVL SDVLHQ \DQJ PHQJDODPL LQIHNVL 7% HNVWUD SDUX MXJD PHQXQMXNNDQ DQJND \DQJ VLJQL¿NDQ %HULNXW GLODSRUNDQ WLJD NDVXV 7% HNVWUD SDUX .DVXV SHUWDPD ZDQLWD WDKXQ GHQJDQ JDPEDUDQ NOLQLV EHQMRODQ SDGD GDHUDK PXOXW \DQJ DZDOQ\D GLSHUNLUDNDQ PHQGHULWD WXPRU NHPXGLDQ GLODNXNDQ SHPHULNVDDQ KLVWRSDWRORJLV GLSHUROHK KDVLO SHUDGDQJDQ NURQLN JUDQXORPDWRXV .DVXV NHGXD ZDQLWD WDKXQ GHQJDQ JDPEDUDQ NOLQLV EHUXSD SODN KLSHUNHUDWRVLV HULWHPD GDQ VNXDPD UHJLR LQWHUSKDODQJ GLJLWL dua dextra kemudian dilakukan SHPHULNVDDQ KLVWRSDWRORJLV GLSHUROHK KDVLO 7XEHUNXORVLV NXWLV YHUXNRVD .DVXV NHWLJD ODNL ODNL WDKXQ GHQJDQ Q\HUL GDQ EHQJNDN SDGD OXWXW NDQDQ NHPXGLDQ GLODNXNDQ SHPHULNVDDQ KLVWRSDWRORJLV GLSHUROHK KDVLO UDGDQJ NURQLN JUDQXORPDWRVD VXSXUDWLI 7HUKDGDS NHWLJD SDVLHQ LQL GLEHULNDQ REDW DQWL WXEHUNXORVLV 2$7 NDWHJRUL , +5=( +5 GDQ WHUMDGL SHUEDLNDQ NOLQLV

  Kata kunci:

  7% HNVWUD SDUX REDW DQWL WXEHUNXORVLV

  PENDAHULUAN

  DNDQ PHQHQWXNDQ SHQHJDNDQ GLDJQRVLV GDQ

  7XEHUNXORVLV 7% PHUXSDNDQ SHQ\DNLW SHQDWDODNVDQDDQ DZDO PHQJLQJDW NRQGLVL LQIHNVLXV \DQJ GDSDW PHQJDQFDP Q\DZD LQL GDSDW GLVDODKDUWLNDQ VHEDJDL QHRSODVPD GHQJDQ DQJND LQVLGHQVL \DQJ WLQJJL GL GXQLD DWDX XONXV WUDXPDWLF VHKLQJJD SHQHJDNDQ WHUXWDPD GL QHJDUD QHJDUD EHUNHPEDQJ VHSHUWL GLDJQRVLVSXQ PHQMDGL WHUODPEDW .DNLVL HW al. ,QGRQHVLD 0HVNLSXQ VHEDJLDQ EHVDU NDVXV 7% PHQLQMDX NHPEDOL OLWHUDWXU ,QJJULV GDQ GLWHPXNDQ SDGD SDUX SDUX SURSRUVL SDVLHQ PHQHPXNDQ NDVXV 7% GHQJDQ PDQLIHVWDVL \DQJ PHQJDODPL LQIHNVL 7% HNVWUD SDUX MXJD RUDO 'DODP UHYLVL LQL XVLD UDWD UDWD SDVLHQ PHQXQMXNNDQ DQJND \DQJ VLJQL¿NDQ

  2UJDQLVDVL DGDODK WDKXQ GL PDQD SDVLHQ DGDODK .HVHKDWDQ 'XQLD World Health Organization DQDN DQDN +DQ\D NDVXV \DQJ GLWHPXNDQ pada palatum durum atau palatum molle. :+2 PHQGH¿QLVLNDQ 7% HNVWUD SDUX ([WUDSXOPRQDU\ 7% (37% VHEDJDL µVHRUDQJ

  7XEHUNXORVLV NXWLV YHUXNRVD DGDODK SDVLHQ GHQJDQ WXEHUNXORVLV SDGD RUJDQ VHODLQ JDQJJXDQ SDXVLEDVLOHU \DQJ GLVHEDENDQ ROHK SDUX PLVDOQ\D SOHXUD NHOHQMDU JHWDK EHQLQJ UHLQIHNVL HNVRJHQ LQRNXODVL VHWHODK DGDQ\D DEGRPHQ WUDNWXV XURJHQLWDOLD NXOLW WXODQJ

  VHQVLWLVDVL GHQJDQ LPXQLWDV \DQJ WLQJJL GDQ VHQGL VHUWD PHQLQJHV ¶ +DPSLU VHSHUOLPD

  7XEHUNXORVLV NXWLV PHQMDGL PDVDODK NHVHKDWDQ dunia di awal abad kesembilan belas dan awal NDVXV 7% GL $PHULND 6HULNDW DGDODK (37% 'L abad kedua puluh. Chong et al QHJDUD EHUNHPEDQJ VHNLWDU GDUL SHQGHULWD PHODSRUNDQ 7% PHUXSDNDQ SHQGHULWD (37% %HQWXN (37% PDVLK PHUXSDNDQ PDVDODK NHVHKDWDQ

  Address for corespondance : PDV\DUDNDW \DQJ EHVDU NDUHQD PDVLK VXOLW

  (PDLO 'HZL5HVQDZLWD#JPDLO FRP WHUGLDJQRVLV GLPDQD PHPHUOXNDQ SHPHULNVDDQ

  0DUOLQD5D\V#JPDLO FRP SHQXQMDQJ \DQJ KDUXV PHPDGDL

  7% SDODWXP PHUXSDNDQ 7% SDGD DUHD RUDO

• RZ 7R &LWH 7KLV $UWLFOH \DQJ PDVLK GLDQJJDS ODQJND 3HQWLQJ XQWXN

LAPORAN TIGA KASUS

  PHQJHQDOL NRQGLVL LQL NDUHQD KDO WHUVHEXW TUBERKULOSIS EKSTRA PARU ₂₃

  NDVXV 7% NXWLV GDODP SHQHOLWLDQ PHUHND VHODPD 7% GLVDQJNDO 5LZD\DW NRQWDN GHQJDQ SHQGHULWD WDKXQ GL +RQJ .RQJ %HEHUDSD ODSRUDQ 7% GLVDQJNDO 5LZD\DW +LSHUWHQVL GLVDQJNDO PHQXQMXNNDQ EDKZD 7% NXWLV PHZDNLOL VHNLWDU

  5LZD\DW 'LDEHWHV 0HOLWXV GLVDQJNDO 5LZD\DW GDUL VHPXD NDVXV GHUPDWRORJL GLOLKDW GL PHURNRN WLGDN DGD 5LZD\DW NRQVXPVL REDW NOLQLN UDZDW MDODQ REDWDQ WLGDN DGD 5LZD\DW DOHUJL WLGDN DGD

  7XEHUNXORVLV SDGD VHQGL OXWXW GLNHQDO

  3DGD SHPHULNVDDQ ¿VLN GLGDSDWNDQ MXJD VHEDJDL JRQLWLV WXEHUNXORVLV 7XEHUNXORVLV SHQGHULWD VDGDU WDPSDN VDNLW VHGDQJ JL]L WXODQJ GDQ VHQGL SDOLQJ VHULQJ PHQ\HUDQJ VHQGL NXUDQJ 7DQGD YLWDO GDODP EDWDV QRUPDO 3DGD SHQRSDQJ EHUDW EDGDQ VHNLWDU SDGD WXODQJ FDYXP RULV tampak lesi eritematous ukuran EHODNDQJ SDGD SLQJJXO GDQ VHNLWDU SDGD OXWXW *RQLWLV WXEHUNXORVLV PHUXSDNDQ WXEHUNXORVLV SDGD WXODQJ GDQ VHQGL \DQJ SDOLQJ MDUDQJ GLWHPXNDQ

  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 _{Gambar 1. Klinis saat pertama kali datang} 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 JLJL GDQ PHPEHQWXU ODQJLW ODQJLW PXOXW 3DVLHQ tidak ada demam saat ini maupun riwayat demam

  VHEHOXPQ\D %DWXN VHVDN QDSDV PDXSXQ Q\HUL GDGD WLGDN DGD 0XDO PXQWDK Q\HUL XOX KDWL WLGDN DGD 1DIVX PDNDQ PHQXUXQ DGD .HULQJDW PDODP WLGDN DGD %HUDW EDGDQ PHQXUXQ DGD “ NJ GDODP EXODQ WHUDNKLU %XDQJ DLU NHFLO ODQFDU EHUZDUQD NXQLQJ MHUQLK WLGDN DGD GDUDK _{Gambar 2. Foto toraks} %XDQJ DLU EHVDU ELDVD WLGDN DGD GDUDK 5LZD\DW

  

Gambar 3. Ct-scan kepala

  Gambar 5. Klinis setelah pengobatan tiga bulan Gambar 6. Klinis saat pertama kali datang

  VHO VHO OLPIRVLW GHQJDQ NHVDQ SHUDGDQJDQ NURQLN JUDQXORPDWRXV \DQJ VHVXDL XQWXN SURVHV VSHVL¿N 7%

  $ -DULQJDQ GLODSLVL HSLWHO VNXDPRVD EHUODSLV % *UDQXORPD HSLWKHORLG & *UDQXORPD HSLWKHORLG GHQJDQ VHQWUDO QHNURVLV ' 6HO GDWLD ODQJKDQV GDQ VHO OLPIRVLW

  VHO OLPIRVLW \DQJ PHQJHOLOLQJL JUDQXORPD WLGDN WDPSDN DGDQ\D VWUXNWXU MDPXU SDGD VHGLDDQ kesimpulan tuberculosis kutis verukosa. ^{A C B D Gambar 4.}

  6SXWXP %7$ [ QHJDWLI QHJDWLI QHJDWLI 'LODNXNDQ SHPHULNVDDQ SHQXQMDQJ EHUXSD ELRSVL NXOLW GHQJDQ KDVLO VHGLDDQ MDULQJDQ GLODSLVL HSLGHUPLV \DQJ WDPSDN KLSHUSODVLD SVHXGRHSLWHOLRPVWRXV KLSHUNHUDWRVLV DNDQWRVLV GDODP GHUPLV WHUGDSDW JUDQXORPD HSLWHORLG GHQJDQ EHEHUDSD VHO GDWLD ODQJKDQV GDQ EDQ\DN

  3HPHULNVDDQ ODERUDWRULXP GDODP EDWDV normal. Foto polos toraks dalam batas normal.

  GLGDSDWNDQ HIÀRUHVHQVL EHUXSD SODN KLSHUNHUDWRVLV HULWHPD GDQ VNXDPD 7LGDN WDPSDN DGDQ\D SHPEHVDUDQ NHOHQMDU

  dextra

  VDGDU GHQJDQ VDNLW ULQJDQ GDQ JL]L FXNXS 7DQGD YLWDO GDODP EDWDV QRUPDO 3DGD SHPHULNVDDQ GHUPDWRORJLV UHJLR LQWHUSKDODQJ GLJLWL dua

  3DGD SHPHULNVDDQ ¿VLN GLGDSDWNDQ SDVLHQ

  VHPDNLQ ODPD PHOHEDU GDQ PHQHEDO 7HUDVD JDWDO GDQ WLGDN Q\HUL 5LZD\DW EHUREDW GL GRNWHU spesialis namun tidak ada perbaikan. Demam GDQ ULZD\DW GHPDP VHEHOXPQ\D WLGDN DGD 6HVDN QDSDV EDWXN GDQ Q\HUL GDGD WLGDN DGD 0XDO PXQWDK GDQ Q\HUL XOX KDWL WLGDN DGD 1DIVX PDNDQ EDLN %HUDW EDGDQ PHQXUXQ GLVDQJNDO .HULQJDW PDODP GLVDQJNDO %XDQJ DLU NHFLO ODQFDU EHUZDUQD NXQLQJ MHUQLK WLGDN DGD GDUDK %XDQJ DLU EHVDU ELDVD WLGDN DGD GDUDK 5LZD\DW DOHUJL REDW GDQ PDNDQDQ GLVDQJNDO 5LZD\DW SHQ\DNLW ODLQ GLVDQJNDO 5LZD\DW PHQGHULWD EDWXN ODPD GLVDQJNDO 5LZD\DW NRQWDN GHQJDQ SHQGHULWD 7% GLVDQJNDO 5LZD\DW NHOXDUJD GHQJDQ NHOXKDQ \DQJ VDPD GLVDQJNDO

  1\ 0 WDKXQ LEX UXPDK WDQJJD PHQJXQMXQJL SROL SDUX 56 :DKLGLQ 6XGLURKXVRGR \DQJ VHEHOXPQ\D GLNRQVXO GDUL SROL NXOLW GHQJDQ NHOXKDQ EHUFDN PHQHEDO GL MDUL WHOXQMXN NDQDQ .HOXKDQ GLUDVDNDQ VHMDN HQDP EXODQ \DQJ ODOX $ZDOQ\D KDQ\D EHUXSD ELQWLN NHFLO PHUDK \DQJ

  3HQDQJDQDQ SDGD SDVLHQ LQL 2$7 NDWHJRUL

  %HUGDVDUNDQ DQDPQHVLV SHPHULNVDDQ ¿VLN GDQ SHPHULNVDDQ SHQXQMDQJ PDND GLDJQRVLV pasien ini adalah tuberkulosis pada palatum.

  VHQWUDO QHNURVLV EDQ\DN VHO GDWLD ODQJKDQV GDQ

  NDVXV 7% NXWLV GDODP SHQHOLWLDQ PHUHND VHODPD WDKXQ GL +RQJ .RQJ %HEHUDSD ODSRUDQ PHQXQMXNNDQ EDKZD 7% NXWLV PHZDNLOL VHNLWDU GDUL VHPXD NDVXV GHUPDWRORJL GLOLKDW GL NOLQLN UDZDW MDODQ

  PHOXDV NH VLQXV PD[LOODULV GDQ PHQGHVWUXNVL WXODQJ VHNLWDUQ\D )RWR WRUDNV GDODP EDWDV QRUPDO 6SXWXP EDVLO WDKDQ DVDP %7$ [ QHJDWLI QHJDWLI QHJDWLI +DVLO 3DWRORJL $QDWRPL GDUL RUJDQ SDODWXP GLGDSDWNDQ VHGLDDQ MDULQJDQ GLODSLVL HSLWHO VNXDPRVD EHUODSLV GLEDZDKQ\D WHUGDSDW EDQ\DN JUDQXORPD HSLWKHORLG GHQJDQ

  &7 6FDQ NHSDOD PDVVD SDODWXP \DQJ

  3HPHULNVDDQ SDUX GDODP EDWDV QRUPDO Hasil

  [ FP SDGD SDODWXP PROOH WLGDN DGD GDUDK SHUPXNDDQ JUDQXOHU Q\HUL WHNDQ WLGDN DGD

  FDYXP RULV

  3DGD SHPHULNVDDQ ¿VLN GLGDSDWNDQ SHQGHULWD VDGDU WDPSDN VDNLW VHGDQJ JL]L NXUDQJ 7DQGD YLWDO GDODP EDWDV QRUPDO 3DGD

  5LZD\DW 'LDEHWHV 0HOLWXV GLVDQJNDO 5LZD\DW PHURNRN WLGDN DGD 5LZD\DW NRQVXPVL REDW REDWDQ WLGDN DGD 5LZD\DW DOHUJL WLGDN DGD

  7% GLVDQJNDO 5LZD\DW NRQWDN GHQJDQ SHQGHULWD 7% GLVDQJNDO 5LZD\DW +LSHUWHQVL GLVDQJNDO

  VHEHOXPQ\D %DWXN VHVDN QDSDV PDXSXQ Q\HUL GDGD WLGDN DGD 0XDO PXQWDK Q\HUL XOX KDWL WLGDN DGD 1DIVX PDNDQ PHQXUXQ DGD .HULQJDW PDODP WLGDN DGD %HUDW EDGDQ PHQXUXQ DGD “ NJ GDODP EXODQ WHUDNKLU %XDQJ DLU NHFLO ODQFDU EHUZDUQD NXQLQJ MHUQLK WLGDN DGD GDUDK %XDQJ DLU EHVDU ELDVD WLGDN DGD GDUDK 5LZD\DW

  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 JLJL GDQ PHPEHQWXU ODQJLW ODQJLW PXOXW 3DVLHQ

  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

  7XEHUNXORVLV SDGD VHQGL OXWXW GLNHQDO MXJD VHEDJDL JRQLWLV WXEHUNXORVLV 7XEHUNXORVLV WXODQJ GDQ VHQGL SDOLQJ VHULQJ PHQ\HUDQJ VHQGL SHQRSDQJ EHUDW EDGDQ VHNLWDU SDGD WXODQJ EHODNDQJ SDGD SLQJJXO GDQ VHNLWDU SDGD OXWXW *RQLWLV WXEHUNXORVLV PHUXSDNDQ WXEHUNXORVLV SDGD WXODQJ GDQ VHQGL \DQJ SDOLQJ MDUDQJ GLWHPXNDQ

• 5=( +5 VHODPD EXODQ \DQJ GDSDW GLSHUSDQMDQJ VDPSDL EXODQ 6HWHODK PHQGDSDWNDQ WHUDSL VHODPD WLJD EXODQ NRQGLVL pasien semakin membaik.

  'DUL DQDPQHVLV SHPHULNVDDQ ¿VLN GDQ SHPHULNVDDQ SHQXQMDQJ GLWHJDNNDQ

  7Q (' WDKXQ VHRUDQJ QHOD\DQ 3DVLHQ GLDJQRVLV 7XEHUFXORVVL NXWLV YHUXNRVD PHQJHOXKNDQ Q\HUL SDGD OXWXW NDQDQ GLDODPL

  7HUDSL \DQJ GLEHULNDQ DGDODK 2$7 NDWHJRUL ,

  VHMDN EXODQ PHPEHUDW VHMDN PLQJJX WHUDNKLU

• 5=( +5 Q\HUL GLUDVDNDQ WHUXV PHQHUXV Q\HUL PHPEHUDW

  MLND OXWXW GLJHUDNNDQ VHKLQJJD SDVLHQ NHVXOLWDQ untuk meluruskan lutut kanannya. Awalnya SDVLHQ PDVLK GDSDW EHUMDODQ WHWDSL ODPD NHODPDDQ Q\HUL VHPDNLQ PHPEHUDW VHKLQJJD SDVLHQ WLGDN GDSDW EHUMDODQ GDQ KDQ\D ELVD GXGXN VHUWD _{A B} EHUEDULQJ VHKLQJJD NDNL NLUL WHUOLKDW PHQJHFLO GLEDQGLQJNDQ GHQJDQ NDNL NDQDQ %HQJNDN SDGD OXWXW NDQDQ GLDODPL VHMDN EXODQ \DQJ ODOX

  VHPDNLQ ODPD VHPDNLQ PHPEHVDU PHPEHUDW

  VHMDN EXODQ WHUDNKLU EHQJNDN GLUDVDNDQ KLQJJD NH NDNL 'DHUDK VHNLWDU OXWXW WHUDED OXQDN WLGDN _C nyeri pada penekanan dan tidak kemerahan.

  5LZD\DW Q\HUL GDQ EHQJNDN SDGD OXWXW GLDODPL

  VHMDN WHUMDWXK GDUL SHUDKX VHNLWDU EXODQ \DQJ

  Gambar

7. Foto hasil pemeriksaan

  ODOX GDQ OXWXW WHUEHQWXU NH VLVL SHUDKX \DQJ

  histopatologi A. Granuloma epiteloid dan

limfosit yang mengelilingi B. Hiperplasia PHQJDNLEDWNDQ OXND WHUEXND WHWDSL WLGDN SHUQDK

pseudoeritomatous C. Sel Datia langhans

  PHQGDSDW SHQJREDWDQ 'HPDP DGD WLGDN WHUXV PHQHUXV SROD GHPDP WLGDN MHODV GLVHUWDL SHQXUXQDQ EHUDW EDGDQ VHNLWDU NJ GDODP EXODQ WHUDNKLU WHUGDSDW SHQXUXQDQ QDIVX PDNDQ OHPDV GDQ NHULQJDW PDODP WLGDN DGD NHOXKDQ Q\HUL SDGD SHUVHQGLDQ ODLQ %DWXN WLGDN DGD VHVDN GDQ Q\HUL GDGD WLGDN DGD 5LZD\DW EDWXN ODPD WLGDN DGD 5LZD\DW NRQWDN GHQJDQ _{Gambar 8. 14 hari post terapi bulan pertama. Tampak} SHQGHULWD 7% GLVDQJNDO 5LZD\DW SHQJREDWDQ _{penebalan dan skuama sedikit berkurang} 2$7 WLGDN DGD 5LZD\DW GLDEHWHV PHOOLWXV WLGDN DGD 5LZD\DW GLGLDJQRVD PHQJLGDS +,9 GDQ menderita penyakit autoimun tidak ada.

  3DGD SHPHULNVDDQ ¿VLN GLWHPXNDQ SDVLHQ

  VDGDU WDPSDN VDNLW VHGDQJ GDQ JL]L NXUDQJ

  7HUDED PDVVD UHJLR JHQX GH[WUD XNXUDQ [ FP WHUDED OXQDN SDGD SDOSDVL HGHPD SUHWLELDO KLQJJD GRUVXP SHGLV DGD GLVHUWDL Q\HUL GDQ OLQJNXS JHUDN WHUEDWDV WLGDN GLWHPXNDQ SHPEHVDUDQ NHOHQMDU JHWDK EHQLQJ 7HUGDSDW DWUR¿ RWRW SDGD WXQJNDL NLUL

  3DGD SHPHULNVDDQ IRWR JHQX SRVLVL anterior-posterior dan lateral didapatkan tampak destruksi pada distal femur dan

SUR[LPDO WLELD

  tidak tampak

  SHULRVWHDO UHDFWLRQ WDPSDN VRIW WLVVXH VZHOOLQJ GL JHQX dextra 3HQHULNVDDQ _{Gambar 9. 30 hari post terapi bulan pertama. Tampak} 06&7 scan JHQX WDQSD NRQWUDV PHQXQMXNNDQ _{penebalan dan skuama sangat berkurang} PXOWLSHO OHVL OLWLN GLVHUWDL GHVWUXNVL \DQJ

  PHOLEDWNDQ GLVWDO IHPXU SURNVLPDO WLELD ¿EXOD GDQ SDWHOD GH[WUD VHVXDL JDPEDUDQ RVWHRP\HOLWLV

• 5=( +5

  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 ^{A B} _{yang melimpah dikelilingi oleh histiosit epitelioid yang menyatu membentuk sel raksasa}

  perifer tampak sel-sel berinti

  EHVDU VHGLNLW DWLSLN GDQ KLSHUNURPDWLN GHQJDQ

  VLWRSODVPD \DQJ FXNXS 7DPSDN VHEDUDQ VHO

  VHO GDWLD EHULQWL OHELK GDUL VDWX PXOWLQXFOHDWHG

  giant cell

  .HVDQ UDGDQJ NURQLN JUDQXORPDWRVD supuratif. ^{Gambar 10. Foto klinis}

  %HUGDVDUNDQ JHMDOD NOLQLV

  GHQJDQ KDVLO WHUGLUL GDUL IRNXV IRNXV VHQWUDO QHNURWLN \DQJ GLNHOLOLQJL VHO VHO UDGDQJ 301

  VHUWD KDVLO SHPHULNVDDQ SHQXQMDQJ SDVLHQ GLGLDJQRVLVVHEDJDL *RQLWLV

  7XEHUNXORVLV 'H[WUD GLEHULNDQ WHUDSL 2$7 NDWHJRUL ,

  DISKUSI

  0 WXEHUFXORVLV masuk ke dalam tubuh

  PDQXVLD PHODOXL LQKDODVL GURSOHW \DQJ PHQJDQGXQJ EDNWHUL LQL ,QIHNVL SULPHU ELDVDQ\D WHUMDGL GL SDUHQNLP SDUX \DQJ GDSDW PHPEDLN 1DPXQ GHPLNLDQ RUJDQLVPH WHUVHEXW tetap hidup di dalam fokus infeksi dalam paru GDQ GDSDW PHQJDODPL UHDNWLYDVL VHKLQJJD menyebabkan rekurensi dari penyakit ini.

  .DVXV SHUWDPD ZDQLWD WDKXQ GLGLDJQRVLV 7% SDODWXP 0DQLIHVWDVL RUDO 7%

  VDQJDW PHQ\HUXSDL OHVL PDOLJQD GDQ DWDX XONXV

   SRO\PRUSKRQXFOHDU GDQ OLPIRVLW 3DGD EDJLDQ

  IHPXU 'LODNXNDQ SHPHULNVDDQ KLVWRSDWRORJLV

VSLQGOH LQWL OHELK

  VDGDU WDPSDN VDNLW VHGDQJ GDQ JL]L NXUDQJ

  7Q (' WDKXQ VHRUDQJ QHOD\DQ 3DVLHQ PHQJHOXKNDQ Q\HUL SDGD OXWXW NDQDQ GLDODPL

  VHMDN EXODQ PHPEHUDW VHMDN PLQJJX WHUDNKLU Q\HUL GLUDVDNDQ WHUXV PHQHUXV Q\HUL PHPEHUDW MLND OXWXW GLJHUDNNDQ VHKLQJJD SDVLHQ NHVXOLWDQ SDVLHQ PDVLK GDSDW EHUMDODQ WHWDSL ODPD NHODPDDQ Q\HUL VHPDNLQ PHPEHUDW VHKLQJJD SDVLHQ WLGDN GDSDW EHUMDODQ GDQ KDQ\D ELVD GXGXN VHUWD EHUEDULQJ VHKLQJJD NDNL NLUL WHUOLKDW PHQJHFLO GLEDQGLQJNDQ GHQJDQ NDNL NDQDQ %HQJNDN SDGD OXWXW NDQDQ GLDODPL VHMDN EXODQ \DQJ ODOX

  VHPDNLQ ODPD VHPDNLQ PHPEHVDU PHPEHUDW

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