Background: Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae (M. leprae) that primarily infects Schwann cells in the peripheral nerves, leading to nerve damage and the development of disabilities. In 2018, Indonesia was the third country with the most leprosy cases in the world. Erythema nodosum leprosum (ENL), also known as type II leprosy reaction, is a severe immune-mediated complication of multibacillary leprosy. Purpose: To report a case of borderline lepromatous leprosy with severe ENL. Case: A 49-year-old Balinese man presented with multiple tender erythematous skin nodules all over his body, fever, arthralgia, bilateral cervical lymphadenopathy, and sensory loss for the past week. The acid-fast bacilli bacteriological examination showed a positive result. The patient was diagnosed with borderline lepromatous (BL) leprosy with severe ENL and was treated with multibacillary multidrug therapy (MB MDT), methylprednisolone, and other symptomatic medications. After 1 month of treatment, there was an improvement in skin lesions. The MB-MDT treatment was continued and methylprednisolone was planned to be tapered down gradually. Discussion: Approximately 20-50% of all leprosy patients show leprosy reactions in the course of the disease. The goals of treatment for severe ENL are to control inflammation, reduce pain, treat neuritis to prevent nerve dysfunction and contractures, and prevent recurring ENL. The prognosis of leprosy with ENL reactions depends on the severity of the occurring leprosy reaction; early diagnosis and prompt treatment; and patient compliance with treatment. Conclusion: Early diagnosis and treatment are essential to avoid deformities in leprosy patients.

Background: Disseminated herpes zoster (HZ) is one of the complications of HZ in the form of the appearance of the main lesion accompanied by the spread of solitary vesicles on the body. This condition occurs in 2% of the general population and 15-30% of immunodeficient patients, such as the elderly and HIV infection. Case presentation: A 64-year-old man came with the complaint of rashes all over his body four days ago. Vesicles and erosions are multiple in 1 dermatome and are discrete and scattered throughout the body on dermatological examination. The diagnosis of disseminated HZ, in this case, was established based on history, physical examination, and Tzank examination. HZ spread is less common and is characterized by the appearance of more than 20 vesicles or more than 2 consecutive dermatomes. Old age and HIV infection are immunocompromised conditions causing reactivation of the varicella-zoster virus and other infections. The patient received oral acyclovir, vitamins B1, B6, and B12, salicylic powder and topical fusidic acid, antiretrovirals (ARVs), azithromycin, intraoral cotrimoxazole, ceftriaxone, and intravenous fluconazole for 10 days. Skin lesions improved in 10 days without complications. Conclusion: Disseminated HZ in HIV patients should be considered because of complications, recurrence, more difficult with a treat, and a higher risk of acyclovir resistance.

Background: ISS, GAP scores and the cytokines IL-6 reflects the severity of an injury. Recently levels of the cytokine IL-6 are the best biomarker that reflects the severity of the trauma. There has been no research on the relationship between ISS and GAP scores with IL-6 cytokine level in fracture patients with multiple traumas. This study is a cross-sectional observational study. Methods: All fracture patients treated at Sanglah Emergency Unit started in January 2016 that met the inclusion criteria became sample. At sample, we calculate ISS and GAP scores and took blood samples for examination of IL-6 cytokine level. Bivariate analysis performed by Chi-square to determine the relationship between ISS and GAP score with IL-6 cytokine level. Results: Samples were 60 patients from January to April 2016. In this study, the correlation between the ISS and IL-6 cytokines was 0.05 (p=0.705), whereas the correlation between GAP scores and IL-6 cytokines was -0.399 (p=0.002). Conclusions: In this study there was positive correlation that weak and not significant between the ISS and IL-6 cytokines and there was a negative correlation that had moderate strength and significant between GAP scores and IL-6 cytokines.