Background: Turner syndrome is characterized by abnormality of one X chromosome. Those with Turner syndrome are at risk of developing tuberculosis infection due to decreased immune function. Case: A 17-year-old girl came with complaints of short stature, amenorrhea, and no signs of secondary sexual growth. She also felt weak. On physical examinations, she weighed 24 kg, and her height was 119 cm. Her conjunctiva looked pale. She had a low set hairline, small mandible, short 4th metacarpal, and wide-spaced nipple. Her breast and genitalia did not grow (1st stage of Tanner classification). There was a lesion between her breasts. Laboratory results showed Hemoglobin 7 g/dL, MCV 62,6 fL, MCH 18,2 pg, MCHC 29 g/L, FSH >170 IU/L, LH 95,3 IU/L, Estradiol 11 pg/mL, Iron Ferrozine 7 mg/dL, TIBC 186 μg/dL, and Ferritin 50 ng/mL. Her Mantoux test showed induration with a diameter of 20-23 mm, and the Xpert MTB-RIF test showed low detection of MTB. Her bone age was appropriate for a 13-year-old girl. Histopathology test of her lesion showed chronic granulomatous inflammation. Her chromosome analysis showed Mos 45,X(56)/46,XX(44). She was diagnosed with Turner syndrome and tuberculosis. She received Progynova® 2 mg every 24 hours for 21 days, stopped for 10 days, and continued again for 21 days. She also got anti-tuberculosis drugs (pediatric regime). Conclusion: The clinical spectrums of Turner syndrome vary widely. Decreased immune function in Turner syndrome can lead to infections such as tuberculosis. Early diagnosis and treatment can prevent further morbidity.

Background: Congenital malformations contribute to neonates’ mortality. Cleft lip is one of the most common congenital malformations. It’s usually accompanied by other organs’ malformations, such as cardiovascular system. This case report aims to increase the awareness about other congenital malformations which can accompany cleft lip. Case: Baby girl born by sectio caesarea from 39 weeks of pregnancy with premature rupture of membrane. Antenatal USG examination showed that baby was in breech position and suspect congenital malformation. She cried immediately after delivery and had good muscle tone. On examinations, she weighed 2.200 grams, her length was 46 cm, and her head circumference was 30 cm. Her vital signs showed heart rate 152 beats/minute, respiratory rate 50 times/minute, temperature 36.8oC, and SpO2 98%. A cleft on right nose, lip, and palate was found. No abnormalities in thorax, abdomen, vertebra, and extremities examinations. Echocardiography examination showed suspect PFO, mild tricuspid regurgitation, and trivial mitral regurgitation. Her SpO2 dropped to 90% while in perinatology room so she received 0.5-1 liter/minute oxygen supplementation using nasal cannula. On the 7th day, we found secrets on both eyes. Gram examination was done and it tested negative. She received levofloxacin eye drop every 2 hours on both eyes. She was breastfed using specially-designed pacifier. On the 10th day, she was discharged in a good condition. Conclusion: Cleft lip is usually accompanied by other organs’ malformations, such as cardiovascular system. Comprehensive examinations must be done for every baby born with cleft lip.   Latar Belakang: Malformasi kongenital berkontribusi terhadap angka mortalitas bayi. Bibir sumbing merupakan kelainan kongenital yang sering terjadi dan biasanya disertai malformasi organ lain, seperti sistem kardiovaskular. Penulisan laporan kasus ini bertujuan meningkatkan kewaspadaan terhadap kelainan bawaan yang mungkin menyertai bibir sumbing. Kasus: Bayi perempuan dilahirkan secara sectio caesarea dari kehamilan berusia 39 minggu 6 hari yang disertai ketuban pecah dini. Pemeriksaan USG saat kehamilan menunjukkan bayi letak sungsang dan curiga kelainan kongenital. Ketika lahir, bayi segera menangis dan tonus kuat sehingga dilakukan perawatan rutin. Pada pemeriksaan, bayi memiliki berat lahir 2.200 gram, panjang badan 46 cm, dan lingkar kepala 30 cm. Tanda vital menunjukkan denyut jantung 152 kali/menit, laju pernafasan 50 kali/menit, suhu 36.8oC, dan SpO2 98%. Pada pemeriksaan kepala ditemukan celah pada hidung, bibir, dan langit-langit mulut kanan serta tidak ditemukan kelainan pada thoraks, abdomen, vertebra, dan ekstremitas. Pemeriksaan echocardiography menunjukkan suspek PFO, mild tricuspid regurgitation, dan  trivial mitral regurgitation. Saat perawatan di ruang perinatologi, terjadi penurunan SpO2 menjadi 90% sehingga bayi menerima suplementasi oksigen dengan kanula nasal 0.5-1 liter/menit. Pada hari ke 7, ditemukan sekret putih kekuningan di kedua mata sehingga dilakukan pemeriksaan gram dan hasilnya negatif. Bayi kemudian diberikan levofloksasin tetes mata setiap 2 jam di kedua mata. ASI tetap diberikan menggunakan dot khusus dan pada hari ke 10 bayi diizinkan pulang dalam keadaan baik. Simpulan: Bibir sumbing biasanya disertai kelainan organ lain seperti sistem kardiovaskular. Oleh karena itu, pemeriksaan yang komprehensif harus dilakukan pada setiap kasus bibir sumbing.

Background: Under-five populations are at higher risk of Staphylococcal Scalded Skin Syndrome (SSSS). The incidence of SSSS in developing countries is still a concern because the staphylococcal infection rate is high. This report aims to describe the clinical profiles of SSSS in infants below 1-year-old. Case: 7 month-old baby boy came with a chief complaint of skin blister for 7 days. It had been preceded by erythema on the right axilla, which turned into blisters on both axilla, perioral, trunk region, and both extremities the following day. The complaint was accompanied by fever. Five days before, he had experienced the common cold. On examinations, he was alert, weighed 9.1 kg, with a heart rate of 134 beats/minute, respiratory rate 40 times/minute, SpO2 98%, and axillary temperature 37.8oC. There were crusts and blisters on the face and trunk with positive Nikolsky’s sign. Genital and lower extremities looked erythematous. Laboratory results showed leukocytes 19,240/uL, neutrophil 50.7%, lymphocytes 35.2%, hemoglobin 9.9 g/dL, hematocrit 30.2%, and platelet 679,000 /uL. He was diagnosed with SSSS and was suggested for hospitalization. He received maintenance fluid therapy with D5%:¼NS 100 ml/kg/day, Cefotaxime injection 3 x 35 mg/kg, Paracetamol syrup 3 x 10 mg/kg, Fusidic Acid 2% cream twice a day, Gentamicin eye ointment 0.3% twice a day, and non-adherent dressing twice a day. He was discharged in good condition after 5 days of hospitalization. Conclusion: The knowledge about the clinical profiles of SSSS is important in order to give rapid management and reduce mortality.   Latar Belakang: Populasi di bawah usia 5 tahun rentan mengalami Staphylococcal scalded skin syndrome (SSSS). Di negara-negara berkembang, insidens SSSS masih tinggi karena infeksi staphylococcus masih banyak terjadi. Laporan kasus ini ditulis untuk memberi gambaran mengenai SSSS pada bayi berusia di bawah 1 tahun. Kasus:  Bayi laki-laki berusia 7 bulan dibawa dengan keluhan utama kulit melepuh sejak 7 hari sebelumnya. Keluhan didahului kemerahan di ketiak kanan dan keesokan harinya, kulit di ketiak kanan, kiri, dan daerah sekitar bibir, dada, perut, kemaluan, serta kedua tungkai melepuh. Dua hari kemudian, kulit di seluruh tubuh mengelupas. Keluhan disertai dengan demam. Lima hari sebelumnya, pasien mengalami pilek. Pada pemeriksaan, pasien sadar dengan berat badan 9,1 kg, denyut nadi 134 kali/menit, laju pernafasan 40 kali/menit, SpO2 98%, dan suhu aksila 37,8oC. Kulit tampak melepuh disertai krusta pada wajah, dada, abdomen,dan punggung. Tanda Nikolsky positif. Daerah ekstremitas bawah dan genital tampak kemerahan. Pemeriksaan darah menunjukkan leukosit 19.240/uL, neutrofil 50,7%, limfosit 35,2%, hemoglobin 9,9 g/dL, hematokrit 30,2%, dan trombosit 679.000 /uL. Dokter mendiagnosis pasien mengalami SSSS dan menyarankan rawat inap. Pasien menerima terapi cairan rumatan dengan D5%:¼NS 100 ml/kg/hari, Cefotaxime injeksi 3 x 35 mg/kg, Parasetamol sirup 3 x 10 mg/kg, krim Asam Fusidat 2% 2 kali/hari, salep mata Gentamisin 0,3% 2 kali/hari, dan perawatan luka 2 kali/hari. Setelah dirawat selama 5 hari, pasien sembuh dan diizinkan pulang. Simpulan: Pengetahuan mengenai gambaran klinis SSSS penting untuk memberi tatalaksana yang cepat dan tepat sehingga mortalitas dapat ditekan.

Introduction: Acute respiratory tract infection (ARI) is the major cause of mortality and morbidity in low – and middle–income countries. Bronchiolitis is the most common respiratory tract infection in <2 years old individuals but is often confused with bronchial asthma. This report aims to describe the difference between those two diseases. Case: Eight–month–old baby girl presented with shortness of breath, abnormal breathing sound, productive cough, fever, nasal discharge, and vomiting for 3 days. She’s got a history of abnormal breathing sound at 4 months old. Parents had no history of allergy or asthma. On examination, she was alert, weighed 6,8 kg, had an axillary temperature of 37°C, heart rate of 128/min, respiratory rate of 56/min with subcostal retraction, rhonchi, and wheezing on both chests. Laboratory findings showed hemoglobin of 11,2 g/dL, hematocrit of 32,3%, leukocyte count of 10.810/mm³, thrombocyte count of 361.000/mm³. Serum electrolytes and blood sugar levels were within normal limits. Chest radiograph showed patchy perihilar infiltrates on both lungs and hyperinflation. She was diagnosed with bronchiolitis and was treated with KAEN3B 700 cc/24 hours, nasal oxygen 2 L/min, 3 x 200 mg ampicillin, 2 x 15 mg gentamicin, 3 x 1 mg dexamethasone, ipratropium bromide and albuterol nebulization 3 times daily, 3 x 70 mg oral paracetamol. Her condition improved, and she was discharged after 7 days of hospitalization. Conclusion: There are fundamental differences in clinical profiles between bronchiolitis and bronchial asthma, which have to be carefully examined to prevent misdiagnosis.   Latar Belakang: Infeksi saluran pernafasan akut (ISPA) merupakan masalah utama penyebab mortalitas dan morbiditas di negara berpenghasilan menengah ke bawah. Bronkiolitis merupakan salah satu infeksi saluran nafas tersering pada anak berusia di bawah 2 tahun yang sering dikira sebagai asma bronkial. Laporan ini bertujuan untuk memberi gambaran perbedaan antara kedua penyakit tersebut. Kasus: Bayi perempuan berusia 8 bulan datang dengan keluhan sesak, suara nafas abnormal, batuk berdahak, demam, pilek, dan muntah selama 3 hari. Pasien memiliki riwayat suara nafas abnormal pada usia 4 bulan. Baik pasien maupun orangtua tidak memiliki riwayat alergi maupun asma bronkial. Pada pemeriksaan fisik, pasien sadar, berat badan 6,8 kg, suhu aksila 37° C, nadi 128 kali/menit, laju pernafasan 56 kali/menit, dan didapatkan retraksi subkostal, ronkhi, serta wheezing pada kedua lapang paru. Hasil laboratorium menunjukkan kadar hemoglobin 11,2 g/dL, leukosit 10.810/mm3, trombosit 361.000/mm3, hematokrit 32,3% dengan kadar elektrolit normal. Pemeriksaan foto toraks menunjukkan gambaran hiperinflasi serta patchy infiltrates pada perihilar kanan dan kiri. Pasien didiagnosis menderita bronkiolitis dan mendapatkan terapi cairan dengan KAEN3B 700 cc/ 24 jam, injeksi ampisilin 3 x 200 mg, injeksi gentamicin 2 x 15 mg, injeksi dexamethasone 3 x 1 mg, nebulisasi ipratropium bromide dan albuterol 3 kali/ hari, serta parasetamol oral 3 x 70 mg. Pada hari ke 7, pasien dipulangkan dalam kondisi sehat. Simpulan: Terdapat perbedaan mendasar pada gejala klinis bronkiolitis dan asma bronkial yang jika tidak dicermati dengan hati – hati akan menyebabkan kesalahan diagnosis.