Introduction: Stevens-Johnson Syndrome (SJS) is an acute hypersensitivity reaction that manifests on the skin, oral mucosa, ocular, gastrointestinal, genital and anal area. It is also potentially life-threatening in concern of dehydration and infection. Oral mucosal lesions due to SJS resulted in a significant decrease of patient’s quality of life. When the oral mucosa involved, the intake of nutrients and fluids is disrupted contributing to electrolyte imbalance that aggravates dehydration. Moreover, oral mucosal lesions have become an entry point for infection. Purpose: This case report describes the important role of oral medicine specialists in the management of oral mucosal lesions in SJS patient. Review: A 26-year-old female patient was referred from the Department of Dermatology and Venereology with a diagnosis of SJS et causa suspected paracetamol and/or amoxycillin. The complaints comprised of pain on the lips and oral cavity, difficulty in mouth opening, and pain when swallowing. The management for oral lesions included: history taking, external and intra oral examinations, dexamethasone mouthwash, nystatin oral suspension, and sodium chloride (NaCl) 0.9% solution. The patient showed improvement in oral mucosal lesions within 3 weeks of treatment that was provided by oral medicine specialist and medical team collaboration. Conclusion: Based on this case report, the role of oral medicine specialist is very important as part of the management team for SJS patient. Oral medicine specialist can reduce morbidity that results from oral mucosal involvement. Collaboration with oral medicine specialist since the beginning of treatment is the key to success in SJS management. Keywords: Oral medicine specialist, Oral mucosal lesion, Stevens-Johnson Syndrome.

Pendahuluan: Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) adalah reaksi obat yang jarang terjadi, tetapi menimbulkan reaksi klinis yang berat, berupa demam, erupsi kulit, dan keterlibatan organ internal. Terapi medikasi untuk pasien DRESS berupa pemberian kortikosteroid high potent memiliki faktor risiko terjadinya kandidiasis oral selain faktor gangguan imunitas secara sistemik akibat DRESS. Penulisan laporan kasus bertujuan untuk memaparkan faktor risiko dan tatalaksana kandidiasis oral pada pasien DRESS. Laporan kasus: Seorang laki-laki berusia 51 tahun dirawat selama 14 hari dengan diagnosis DRESS oleh bagian Dermatologi dan Venereologi Rumah Sakit Hasan Sadikin Bandung. Terapi intravena yang diberikan adalah Deksametason 20 gram/hari, Vitamin K 3x1 ampul/hari, Omeprazole 1x40 gram/hari, dan Siprofloksasin 2x400 gram/hari. Terapi per oral yang diberikan adalah: Cetirizine 1x10 gram/hari, Curcuma 3x1 kapsul/hari, Asam folat 1x1 tab/hari, Asetilsistein 2x2 mg/hari, serta Callos 1x500 mg/hari. Pasien kemudian dikonsulkan ke bagian Ilmu Penyakit Mulut karena memiliki keluhan sakit pada rongga mulut, tenggorokan, dan bibir sejak 3 hari di RS. Riwayat sariawan berulang disangkal. Pasien tidak pernah menyikat gigi selama rawat inap. Tatalaksana kandidiasis oral diberikan Nystatin in oral suspension 4x200.000 IU/hari, Chlorhexidine digluconate 0,12%, asam hialuronat, NaCl 0,9%, serta Mikonazol krim 2% dan racikan deksametason salep 0,002% diberikan terkait lesi pada bibir dan dioleskan pada sudut mulut. Simpulan: Faktor risiko kandidiasis oral pada pasien DRESS adalah penggunaan kortikosteroid secara sistemik, gangguan imun terkait DRESS, dan kebersihan rongga mulut yang buruk. Tatalaksana kandidiasis oral diberikan adalah antifungal dan antiseptik.Kata kunci: drug reaction with eosinophilia and systemic symptoms; faktor risiko; kandidiasis oral ABSTRACTIntroduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare drug reaction but causes severe clinical reactions in the form of fever, skin eruptions, and involvement of internal organs. Medical therapy for DRESS patients in the form of high potent corticosteroids has a risk factor for oral candidiasis and systemic immune disorders. This case report aimed to describe the risk factors and management of oral candidiasis in DRESS patients. Case report: A 51-year-old male was treated for 14 days with a diagnosis of DRESS by the Department of Dermatology and Venereology of Hasan Sadikin Hospital, Bandung. Intravenous therapy administered was 20 grams/day of Dexamethasone, 3x1 ampoules/day of Vitamin K, 1x40 grams/day of Omeprazole, and 2x400 grams/day of Ciprofloxacin. Oral therapy was 1x10 grams/day of Cetirizine, 3x1 capsules/day of Curcuma, 1x1 tab/day of folic acid, 2x2 mg/day of Acetylcysteine, and 1x500 mg/day of Callos. The patient was then referred to the Department of Oral Medicine because of complaints of pain in the oral cavity, throat, and lips after hospitalisation for three days. History of recurrent thrush was denied. The patient never brushed his teeth during hospitalisation. The management of oral candidiasis was the administration of Nystatin in oral suspension with the dose of 4x200,000 IU/day, 0.12% Chlorhexidine digluconate, hyaluronic acid, 0.9% NaCl, and 2% topical Miconazole,  and a mixture of 0.002% dexamethasone ointment, which was given related to lesions on the lips, and topically administered in the corner of the lips. Conclusion: The risk factors for oral candidiasis in DRESS patients are systemic use of corticosteroids, DRESS-related immune disorders, and poor oral hygiene. The management of oral candidiasis is antifungal and antiseptic.Keywords: drug reaction with eosinophilia and systemic symptoms; oral candidiasis, risk factors

Virus herpes simplex tipe 1 termasuk ke dalam famili Herpesviridae dan subfamili Alphaherpesvirus dengan manusia sebagai reservoir alami virus herpes. Virus herpes simplex tipe 1 bermanifestasi pada oral dan perioral. Setelah terjadi infeksi primer, subkeluarga alphaherpesvirinae akan laten pada saraf ganglia dan dapat reaktivasi. Terjadinya reaktivasi alpha herpesvirinae salah satunya dikarenakan paparan sinar matahari. Laporan kasus ini memaparkan tentang infeksi virus herpes simplex tipe 1 yang tereaktivasi oleh paparan sinar matahari. Pasien laki-laki berusia 37 tahun berobat ke Poliklinik Ilmu Penyakit Mulut RSUP dr. Hasan Sadikin Bandung didiagnosa intraoral herpes rekuren dan kandidiasis pseudomembran akut. Pasien mengeluhkan sudah 1 bulan ini terdapat banyak sariawan pada lidah, gusi dan tenggorokan terasa nyeri sehingga sulit untuk makan dan minum dan lama kelamaan timbul warna putih pada lidah. Ada riwayat demam pada awal terjadi sariawan, riwayat alergi disangkal, pernah sariawan sebelumnya tetapi tidak separah seperti saat ini serta bekerja di kebun dalam satu bulan terakhir. Sudah berobat ke beberapa dokter gigi tetapi tidak ada perbaikan. Penanganan yang dilakukan meliputi, anamnesis, pemeriksaan ekstra oral danintral oral, pemeriksaan laboratorium imunoserologi dan mikrobiologi, tatalaksana farmakologi dan non farmakologi. Pasien menunjukkan perbaikan yang signifikan dalam pengobatan 3 minggu. Artikel ini memaparkan paparan sinarmatahari dapat menyebabkan reaktivasi infeksi virus herpes simplex tipe 1.

Pendahuluan: Lidah dalam filosofi medis dipercaya sebagai barometer kesehatan rongga mulut maupun tubuh secara keseluruhan. Permukaan mukosa lidah kadang memperlihatkan gambaran yang berbeda dari kondisi normal sehingga disebut variasi normal. Geographic tongue dan fissured tongue merupakan suatu variasi normal yang asimptomatik namun dapat menjadi simptomatik ketika dipengaruhi suatu kebiasaan baru yang bersifat mengiritasi seperti setiap hari mengkonsumsi makanan yang memiliki rasa pedas yang ekstrim. Tujuan laporan kasus ini memaparkan tentang kelainan pada variasi normal lidah yang dipicu oleh kebiasaan baru konsumsi makanan tersebut pada seorang pasien remaja. Pasien juga kemudian diketahui dalam kondisi anemia. Laporan kasus: Seorang wanita berusia 18 tahun berobat ke Poliklinik Ilmu Penyakit Mulut RSUP.Dr Hasan Sadikin dengan diagnosis geographic tongue disertai fissured tongue. Pasien mengeluhkan sakit pada lidah dan terasa mati rasa serta nyeri seperti tertusuk-tusuk, terutama jika terkena makanan pedas, sejak satu tahun yang lalu. Terdapat riwayat mengonsumsi makanan yang pedas dan panas hampir setiap hari. Hasil pemeriksaan penunjang hematologi menunjukkan pasien dalam kondisi anemia. Penatalaksanan yang dilakukan meliputi instruksi menjaga kesehatan rongga mulut, pemberian preparat Fe, B12, dan asam folat, serta obat kumur. Pasien menunjukkan perbaikan dalam  pengobatan selama 3 minggu. Simpulan: Kondisi variasi normal pada lidah yang semula asimtomatik dapat menjadi simtomatik akibat iritasi makanan panas dan pedas, pada pasien dengan kondisi anemia.Kata kunci: Geographic tongue, fissured tongue, variasi normal lidah, makanan pedas dan panas, anemia. ABSTRACTIntroduction: In medical philosophy, the tongue is believed to be a barometer of the oral cavity’s health and the body as a whole. The mucosal tongue surface often shows a different feature from normal conditions, thus called normal variation. Geographic tongue and fissured tongue are normal variations that are asymptomatic but can become symptomatic when influenced by new irritating habits such as daily food consumption with an extremely spicy taste. This case report was aimed to describe abnormalities in normal tongue variation triggered by the new habit of consuming such foods in a teenage patient. The patient was also found to be anaemic. Case report: An 18-year-old woman went to the Oral Medicine Polyclinics of Dr Hasan Sadikin Hospital with a geographic tongue diagnosis accompanied by the fissured tongue. The patient complained of a sore tongue and felt numbness and soreness like being prickly, especially when exposed to spicy food, since one year prior. There was a history of spicy and hot foods consumption almost every day. The results of the haematology examination showed that the patient was in an anaemic condition. The treatment included instructions for maintaining oral health, administration of Fe, B12, folic acid preparations, and mouthwash usage. The patient showed improvement after treatment for three weeks. Conclusion: The condition of normal tongue variation, which initially asymptomatic, can become symptomatic due to irritation of hot and spicy food in anaemic patients.Keywords: Geographic tongue, fissured tongue, normal tongue variations, hot and spicy food, anaemia.

No abstract