BED SIDE TEACHING 2
BED SIDE TEACHING 2HERPES ZOSTERGROUP MEMBERSA. Ayu FaradibaA.
Intan P PutriJefman E Marzuki H YMuh. Firmansyah KamalPriska
ParamitaWahyunita IlhamPATIENTS IDENTITYName: Mr. TGender: MaleAge:
23 y.oMarital Status: SingleReligion: ChristianAddress: Irian
JayaOccupation: ArmyRegistered: 23th March 2013
HISTORY TAKINGAnamnesis: Autoanamnesis
Chief complaint: - Multiple tiny blister with pain below the
lower lip
HISTORY TAKINGFever (+), pain on lesion (+), nausea (-),
vomiting (-), headache(-), dizziness (-), chest pain (-). During
the appearance of disease, urination and defecation within normal
limit.PRESENT HISTORY- Vesicle appeared 2 days ago, with pain.
Location below the lower lip.- 4 days ago, went to hospital with
diagnosed suspect malaria
Past history:history of malaria for 4 days ago.Allergic
history:No Allergic historyFamily history:No family member that
have similar disease with patient
PRESENT STATUSGeneral condition:Moderately
illConsciousness:Compos mentis (Alert)Vital sign:BP: 130/80
mmHgPulse: 62x/minuteRespiratory rate:24x/minuteTemperature: 36,5 0
CHead ExaminationJaundice(-)Pale (-)cyanosis (-)Cor/ Pulmo- within
normal limit/within normal limitThoraxVesiculer, Rh (-/-)
Wh(-/-)AbdomenPeristaltic (+)ExtremitiesEdema
(-)LocalizationUniversal Dermatology Status-Location: regio
perioral-Efflorescence: multiple vesicles, erythematous, and
scaly
Diagnosis: - Herpes Zoster
Treatment: DexamethasoneGentamycin 80 mg/12 h/i.vKenalog oral
base+acyclovirNeurodex 3 x 1Tramadol 2 x 1Acyclovir 5 x 400 mg
RESUME23 y.o male, brought to dermatovenereology department on
March 26th 2013 with chief complain of multiple vesicles appear
below the lower lip since 2 days ago. First, the lesion appearead
only on the right side, and lately spread on both areas. Pain (+),
fever (+) since 4 days ago. He lately suspected got malaria. He has
treated with antipyretic drugs, antibiotics, and antiviral
drugs.Vital sign: BP: 130/80 mmHg, Pulse: 62x/minute, Respiratory
rate: 24x/minute, Temperature: 36,5 CDermatovenereology
:-Location:perioral regionEfflorescence:multiple vesicle,
erythematous, and scaly.
DIAGNOSISHerpes ZoosterDIFFERENTIAL DIAGNOSISHerpes simplex,
impetigo, smallpox, atopic dermatitis, poison ivy, atypical
measles
MANAGEMENTDexamethasoneGentamycin 80 mg/12 h/i.vKenalog oral
base+acyclovirNeurodex 3 x 1Tramadol 2 x 1Acyclovir 5 x 400
mgPROGNOSIS:Bonam
HERPES ZOSTERDefinition :The disease is caused by the varicella
zoster virus that attacks the skin and mucosa. This is a
reactivation of the virus infection that occurs after primary
infection.
DiscussionEtiologyVaricella zoster virusThe incubation period is
7-12 daysActive period of 1 weekResolution period 1-2 weeks
Patophysiology (Cont...)Cont.... (1)
Cont... (2)Clinical ManifestationProdromal pain typically is
described as muscle or toothachelike in origin but may simulate
headache, iritis, pleurisy, brachial neuritis, cardiac pain,
appendicitis or other intra-abdominal disease, or sciatica. This
simulation can result in incorrect tentative diagnoses; however,
the dermatomal distribution usually helps clarify the
diagnosis.Differential DiagnosisHerpes
simplexImpetigoSmallpoxAtopic dermatitisPoison ivyAtypical
measlesLab TestTzanck Smear for diagnose acute infectionViral
culture 3-14 days for viral growth, sensitivitation 30-70%,
spesific 100%Antigen IgM detection Serologic test ELISA,
commonlyPCR DNA VZV detection exc. CSSTreatment Oral therapy
:Analgetic (symptomatic)AntibioticAntiviralAcyclovir 5 x 800 mg/day
(7 days)Valacyclovir 3 x 1000 mg/day (1 dayTricyclic antidepresan-
Amytriptilin 75 mg/dayTopical therapy :MBS talc -> prevent
vesicle rupture.Open compretion-> if theres erotion.Antibiotic
cream -> if theres ulkus.
