Ulkus Aftosa Kompleks Manifestasi Penyakit Crohn

Abstract

Latar Belakang: Ulkus aftosa kompleks mengacu pada ulkus mulut kronis berkaitan dengan gangguan sistemik. Kondisi tersebut, selain menimbulkan rasa sakit dan gangguan fungsi, dapat memperburuk kualitas hidup penderitanya. Tujuan: penulisan ini bertujuan untuk melaporkan keterkaitan antara ulkus aftosa kompleks dengan gangguan gastrointestinal, yaitu penyakit crohn. Kasus dan penanganannya: laki-laki 73 tahun mengeluhkan nyeri mulut sejak 3 bulan lalu, yang disertai dengan perut sebah, kembung dan terkadang nyeri ringan disertai dengan sakit kepala. Saat pemeriksaan, tampak adanya ulkus dengan dasar bergranuler, tepi sedikit meninggi dan tertutup lapisan putih pada mukosa lipatan mukobukal, pipi, dasar mulut dan palatum. Permukaan mukosa bibir dan pipi memberikan gambaran seperti batu bata (cobblestoning). Mengacu pada gejala dan temuan klinis, ditegakkan diagnosis kerja ulkus aftosa kompleks manifestasi gangguan gastrointestinal, susprk penyakit crohn. Terapi awal berupa kombinasi spiramycin-metronidazole, methyl-prednisolone, parasetamol dan larutan kumur perhidrol. Satu minggu kemudian, tampak adanya perbaikan lesi dan aktifitas fungsional. Berdasarkan pemerikasaan dari poli penyakit dalam Rumah Sakit Umum Sardjito (RSS), pasien mendapatkan medikasi lanzoprazole, ulsidex dan enzyplex. Terapi lanjutan berupa methyl-prednisolone dengan dosis tapering, anti jamur topical nistatin untuk mencegah infeksi ikutan dan larutan kumur yeng mengandung Benzydamine HCI untuk mengurangi nyeri. Kesimpulan: Ulkus mulut manifestasi penyakit Chohn mempunyai karakteristik unik dan dapat dibedakan dari ulkus mulut kronis lainnya. Dalam penegakan diagnosis ulkus aftosa kompleks, identifikasi etiologi gangguan sistemik yang tepat akan sangat membantu dalam menetapkan perawatan lesi mulut yang sesuai. Background: complex aphthous refers to chronic oral ulceration, which is related to systemic diseases. This condition can cause oral discomfort, alter the normal oral function anf eventually can decrease the quality of life. Purpose: this paper is intended to report the relationship between complex aphthous with gastrointestinal disorder, in particular crohn’s disease. Case and management: A73 year old man complaint a chronic sore mouth since 3 months ago. Abdominal discomfort, mild indigestion and headache occur accompanied by oral symptoms. Clinically, there were multiple ulcers with granular base, slightindurate border covered with white thick layers at mucobuccal fold, buccal, floor of the mouth and palate mucosa. Labial and buccal mucosa demonstrates a cobblestoning appearance. According to systemic symptoms and oral findings, complex aphthous as manifestation of gastrointestinal diseases, specifically suspected to Crohn’s diseases, is accepted as working diagnosis. Spiramycin combined with Metronidazole, Methyl-prednisolone, Paracetamol and perhidrol mouthwash were given as initial therapy. One week later, it seems some improvement on oral lesion and oral functional activity. From internal Medicine Clinic, Sardjito General Hospital, patient received Lanzoprazole, Ulsidex and Enzyplex. Tapering doses of methyl-prednisolone and oral fungal topical Nystatin for prevention from secondary infection were given as subsequent therapy. Benzydamine mouthwash was given for alleviate sore mouth. Conclusion: Complexs apthous ulcers as manifestation of crohn’s disease have a unique characteristic and quite discriminate to other chronic oral ulceration. In establishing the diagnosis of complex aphthous., the identification of proper etiology would help in determining the appropriate management of the oral lesion.