Acta Medica Indonesiana – The Indonesian Journal of Internal Medicine
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COVID-19 Infection in Chronic Myeloid Leukemia Patients Receiving Tyrosine Kinase Inhibitor in Makassar, Indonesia: A Six-Case Report and Literature Review
Get PDFManagement of chronic myeloid leukemia (CML) in patients who are infected with COVID-19 is a challenging task due to disease-related or treatment-related factors that place such patients at a higher risk of complications. However, a low-infectivity-rate mechanism has been proposed by some researchers. In CML patients with COVID-19 infection, the most important treatment-related factor involves tyrosine kinase inhibitors (TKIs). In this case report, six patients with chronic-phase CML who experienced COVID-19 of mild–moderate severity all continued to receive TKI treatment for CML concurrently with COVID-19 treatment. All patients fully recovered. In the present study, we also review four other cases of COVID-19 infection in CML patients. Outcomes for TKI-treated CML patients who contract COVID-19 are influenced by many factors. Tyrosine kinase inhibitor therapy may benefit CML patients due to its antiviral effect, but the interaction between TKIs and drugs used for COVID-19 treatment requires careful monitoring. An individual approach is needed in every case
Cefepime Induced Encephalopathy in a Non-dialysis Dependent Chronic Kidney Disease Patient: A Case Report
Get PDFCefepime is a frequently used fourth-generation cephalosporin antibiotic for a wide variety of infections. Toxic levels of this drug can cause neurological complications. The most common neurological adverse event of cefepime is headache and lightheadedness. Here, we presented a case of cefepime induced encephalopathy in a 57-year-old female patient with acute on chronic kidney disease. With an accurate diagnosis that requires a high index of clinical suspicion, prompt management was instituted. She had full resolution of symptoms following discontinuation of the medication and also emergent dialysis
Paraganglioma in The Urinary Bladder: A Pitfall in Histopathologic Diagnosis
Get PDFParaganglioma of the urinary bladder is a rare neuroendocrine tumor which originates from the chromaffin tissue of the sympathetic nervous system. It only accounts for about 0.05% of all vesical tumors. Bladder paraganglioma may also present with non-specific symptoms which could easily lead to misdiagnosis. In this report, emphasis on the histomorphology and immunohistochemical profile of the tumor is stressed as the morphological findings could overlap with relatively more common urothelial neoplasms. Distinction from other tumors is of utter importance because of different therapeutic options. Here, we present a case of a 52 year-old, filipino, male, previously diagnosed with colonic tubulovillous adenoma, presenting with dysuria and hematuria who, after undergoing CT Stonogram revealed an incidental finding of a lobulated mass measuring 5.7 cm located at the anteroinferior portion of the urinary bladder wall
A Rare Case of Pulmonary Leiomyosarcoma
Get PDFLeiomyosarcoma commonly occurs in the abdomen, retroperitoneum, large blood vessels, and uterus[1]. Cardiac leiomyosarcoma is a rare and highly aggressive sarcoma. We reported a case of a 63-year-old male with pulmonary artery leiomyosarcoma. Transthoracic echocardiography showed a large 4.4×2.3 cm hypoechoic mass in the right ventricular outflow tract and pulmonary artery. Computed tomography pulmonary angiography showed a filling defect in a similar location. The initial impression was PE, but a tumor was not ruled out. An emergency surgery was performed due to progressively worse chest distress and dyspnea. A yellow mass that had adhered to the ventricular septum and pulmonary artery wall was detected to be compressing the pulmonary valve. Immunohistochemistry confirmed tumor cells positive staining for Desmin and smooth muscle actin and negative staining for S-100, CD34, myogenin, or myoglobin, and KI67(+)80%, indicating leiomyosarcoma. Pulmonary leiomyosarcoma showed a side-inserted heart chamber filling defect in CTA and should be excised when the patient suddenly deteriorated
Pituitary Macroadenoma in a Girl with Male Karyotype: A Rare Case Study
Get PDFMacroadenoma is a tumor that typically develops in the epithelial cells of the pituitary gland. Patients suffering from the condition are often asymptomatic with complaints that are caused by hormonal imbalance. Therefore, chromosome analysis needs to be done to females aged >16 years presenting with amenorrhea. Karyotype 46,XY is a disorder of sex development (DSD) that is caused by the complex process of gene interactions, androgen synthesis, and hormone regulation. The patient initially came to the hospital for a scheduled transsphenoidal surgery due to pituitary macroadenoma, and later complained of primary amenorrhea and atypical external genital. Furthermore, physical examination of genitalia revealed mild clitoromegaly without obvious introitus vagina. Laboratory testing showed elevated prolactin and testosterone level, while ultrasonography imaging revealed the absence of the uterus and ovaries. The brain magnetic resonance imaging (MRI) demonstrated a pituitary adenoma, and cytogenetic analysis showed 46,XY karyotype. Subsequently, hyperprolactinemia, imaging, and histopathology examination were used to confirm pituitary macroadenoma in the patient. It was assumed that the undermasculinized genitalia was caused by hormonal disorders including the deficiency of androgen action or 5-alpha-reductase enzyme. 46,XY DSD has many different symptoms, hence, clinicians need to be aware of potential multifactorial aetiologies. Imaging of internal genitalia, hormonal and chromosomal analysis should be carried out to assess patients with unknown causes of the disorder. Molecular analysis needs to be carried to exclude the possible gene mutation
A Very Young Adult Female Patient with Hepatitis B Flare: A Case Report
Get PDFHepatitis B virus (HBV) infection is a major global health problem. It can cause chronic infection and put people at high risk of death from cirrhosis and liver cancer. This study aims to present a case of chronic hepatitis B flare in a very young adult patient. An 18-year-old previously healthy female presented with jaundice developing in one week, following the previous complaints of nausea, vomiting, abdominal pain, loss of appetite, and tiredness for about three months. The patient had no risk factors for getting HBV infection, but her HBsAg-positive mother was probably an inactive HBV carrier. The hepatitis B serological testing revealed HBsAg positivity, anti-HBs seronegativity, HBeAg positivity, anti-HBe seronegativity, anti-HBc IgM seronegativity, and high levels of HBV DNA detected > 1.70 × 108 IU/mL. There was a sharp increase in serum ALT to ≥ 5-fold ULN. The abdominal ultrasonography revealed a hepatitis feature, unremarkable portal venous flow, and an extrahepatic biliary system. The liver transient elastography revealed 15.6 kPa of liver stiffness, which was in accordance with the F3-F4 fibrosis stage. These features were typical of a hepatitis B flare, the HBeAg-positive chronic hepatitis B, previously known as the immune reactive phase. A long-term nucleos(t)ide analog therapy was programmed with Tenofovir alafenamide 25 mg daily
Additional Chromosomal Abnormalities in Chronic Myeloid Leukemia Patient Treated with First-Line Tyrosine Kinase Inhibitor Therapy: Good or Poor Prognosis?
Get PDFA 33-year-old male came to Policlinic of Hematology-Medical Oncology Dr. Cipto Mangunkusumo General Hospital for routine control of chronic myeloid leukemia (CML) treatment. He was treated with Imatinib Mesylate (IM) for two years. At the beginning of therapy, he showed good treatment response. However, after two years of treatment, he lost complete hematological response (CHR) occured and major molecular response (MMR) was not achieved. This demonstrated drug resistance even with good compliance. Evaluation of therapy through cytogenetic karyotype testing showed complex additional chromosomal abnormalities (ACA) in addition to the Philadelphia chromosome (Ph). Tyrosine kinase inhibitor (TKI) therapy in this type of patients should be replaced with other alternative TKIs. A mutation profiling test is needed to determine alternative TKI. Monitoring in the treatment of CML patients is very important. The presence of ACA indicates disease progression and poor prognosis. Time to change therapy in CML patients must be done appropriately based on the results of hematological, molecular, and cytogenetic testing
Plasmodium Ovale Malaria: Endemic Areas in Indonesia
Get PDFPlasmodium ovale consists of two subspecies – P. ovale wallikeri and P. ovale curtisi. Increased reports of imported malaria ovale in non-endemic regions and mixed infection of P. ovale with other Plasmodium species suggest that P. ovale might be under-detected during routine surveillance. Areas endemic with P. ovale have mostly been reported in African and Western Pacific countries. A recent case report in Indonesia indicated that regions with P. ovale endemicity are not only distributed in Lesser Sunda and Papua, but also in North Sumatra
We Need Epidemiological Study from Our Own Population
Get PDFEpidemiological data is a valuable source for decision-making in a clinical setting or from a public health perspective. It serves not only direct purposes by supporting evidence-based treatment but also indirectly contributes to guidelines and policies in healthcare services. Currently, there remains a pressing need for further epidemiological or population-based studies to be conducted in Indonesia. The availability of health data and information specifically from the Indonesian population is still limited and highly sought after. It is common for us to depend on epidemiological data from foreign countries, but this practice can introduce bias into our decision-making process due to the disparities between their conditions and our own.Indonesia possesses a distinct socio-demographic and health landscape, setting it apart from other countries. The diverse range of diseases, risk factors, healthcare access, health equity, and geographical characteristics all contribute to the uniqueness and variability of health problems within the nation. Specific regions across the Indonesian archipelago encounter health issues that are distinct to their locations. Infectious diseases, particularly tropical diseases, and nutrient deficiencies continue to present significant challenges in numerous provinces throughout Indonesia. Variations are observed across different areas and timeframes of study. These dynamic and variable factors make population studies particularly intriguing. It is the responsibility of clinicians, researchers, and epidemiologists to delve into the intricacies of the population and study its health problems comprehensively
Monoclonal Antibodies for COVID-19 Treatment: Is It an Option in Indonesia?
Get PDFMore than three years after Coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV2), was declared pandemic by World Health Organization, report of COVID-19 hospitalization and death have been decreasing. Even though COVID-19 as global health emergency has been declared end, research in finding and evaluating modalities that can decrease severity and mortality from COVID-19 infection are still on going.Until now, there have been more than 380,000 publications in Pubmed with search term “COVID 19”. Excessive inflammatory activation is an important part of COVID-19 pathogenesis which can be caused by interactions of the virus with the host and modulation of host immune response.2 Better understanding on COVID-19 pathogenesis could improve the strategies to manage COVID-19 infection. Monoclonal antibody is one treatment modality that can be used to target the virus itself or modulate dysregulated immune response in COVID-19. Monoclonal antibodies (mAbs) can halt progression of COVID-19 in high-risk patients. However, considering the limited production and high cost, is this treatment modality an option in Indonesia?Many things have been learned from this pandemic and can be a lesson for preparing the next pandemic or other emerging diseases. Various therapeutic developments to treat COVID-19 have been studied for hospitalized patients and outpatient setting, one of which is the use of variety monoclonal antibodies that showed overall moderate efficacy in decreasing severity and mortality from COVID-19 infection and also good safety. Unfortunately, besides variable efficacy across variants, the cost for monoclonal antibodies (MAbs) are still high which make the access for this treatment options for managing COVID-19 might be limited in low to middle income countries. Feasibility and economical sustainability of mAbs against SARS-CoV-2 seem to be optimal in localized epidemics or small outbreaks