Penatalaksanaan ulserasi oral yang dipicu siklofosfamid pada pasien limfoma sel-B high-grade stadium IV disertai febrile neutropenia
Management of cyclophosphamide triggered oral ulceration in high-grade B-cell lymphoma stage IV with febrile neutropenic patients
Abstract
Pendahuluan: Limfoma sel-B merupakan keganasan sel darah putih tipe non-Hodgkin yang paling sering ditemukan. Gold standard therapy pada kasus ini adalah kemoterapi, akan tetapi obat kemoterapi yang digunakan memberikan efek samping dan mengakibatkan kondisi klinis tertentu setelah beberapa kali pemaparan. Siklofosfamid sebagai salah satu obat kemoterapi, memberikan efek samping berupa penurunan jumlah sel darah putih dan ulserasi pada mukosa mulut. Terputusnya kontinuitas jaringan pada ulser di mukosa mulut mengakibatkan infeksi menjadi lebih patogen dan terjadi nekrosis jaringan. Tujuan laporan kasus ini adalah mengulas ulserasi yang diakibatkan oleh obat kemoterapi seperti siklofosfamid. Laporan kasus: Pasien datang ke Instalasi Gawat Darurat (IGD) Rumah Sakit Hasan Sadikin (RSHS) dengan kondisi lemah dan demam setelah menjalani kemoterapi ke-6 untuk pengobatan limfoma sel-B high grade stadium IV. Obat kemoterapi yang digunakan adalah siklofosfamid, doxorubicin, dan vinkristin. Pasien juga diberi prednison dan rituximab. Pasien tidak dapat mengonsumsi makanan dan minuman dengan optimal karena terdapat sariawan pada mulut. Hasil pemeriksaan laboratorium menunjukkan adanya penurunan nilai hemoglobin, hematokrit, eritrosit, dan leukosit (neutrofil segmen), serta peningkatan nilai ureum dan kreatinin. Ulser nekrotik ditemukan pada jari manis kiri, dan mukosa bukal kiri pasien. Perawatan dilakukan secara komprehensif oleh dokter bagian Ilmu Penyakit Dalam, Ilmu Penyakit Mulut, dan Bedah Plastik. Ulser pada mulut diterapi dengan obat kumur chlorhexidine digluconate 0.12% dan tablet asam folat 400 mcg. Ulser rongga mulut mengalami perbaikan, menyebabkan asupan makanan menjadi lebih baik, sehingga kondisi umum pasien membaik. Simpulan: Penatalaksanaan ulserasi oral yang dipicu siklofosfamid pada pasien limfoma sel-B high-grade stadium IV disertai febrile neutropenia dilakukan dengan terapi farmakologis chlorhexidine digluconate 0.12% dan tablet asam folat 400 mcg, dan terapi non farmakologis berupa instruksi pembersihan gigi dan lidah, memperbanyak minum air putih, menghindari makanan bertekstur keras, dan melakukan kompres ulser mulut yang dimonitor per hari dengan kepatuhan terapi yang dijalani oleh pasien, menghasilkan kondisi umum membaik, dan ulser sembuh pada hari ke-13.
Kata kunci: Siklofosfamid, febrile neutropenia, limfoma sel-B.
ABSTRACT
Introduction: B-cell lymphoma is the most common type of non-Hodgkin's white blood cell malignancy. Gold standard therapy of this case is chemotherapy, but the chemotherapy medications used have side effects and cause certain clinical conditions after several exposures. Cyclophosphamide as one of the chemotherapy medication, provides side effects in the form of a decreasing number of white blood cells and oral mucosa ulcer. Disconnection of tissue continuity in the oral mucosa ulcers causes infection to become more pathogenic and tissue necrosis will occur. The purpose of this case report was to review the ulcerations caused by chemotherapy medications such as cyclophosphamide. Case report: Patient came to the Hasan Sadikin Hospital Emergency Installation with a weak condition and fever after undergoing the 6th chemotherapy for the treatment of high-grade B-lymphoma stage IV. The chemotherapy medications used were cyclophosphamide, doxorubicin, and vincristine. Patients were also given prednisone and rituximab. Patients also unable to ate and drank optimally because there was an oral ulcer. The laboratory tests results showed a decreasing value of haemoglobin, haematocrit, erythrocytes, and leukocytes (neutrophil segments), as well as an increasing amount of ureum and creatinine. The necrotic ulcer was found on the left ring finger, and the left buccal mucosa. The treatment was performed comprehensively by doctors from the Department of Internal Medicine, Oral Medicine, and Plastic Surgery. The oral ulcer was treated with 0.12% chlorhexidine digluconate mouthwash and 400 mcg of folic acid tablets. The oral ulcer has improved, causing better food intake, thus improving the patient's general condition. Conclusion: The management of cyclophosphamide triggered oral ulceration in high-grade B-cell lymphoma stage IV with febrile neutropenic patients is carried out with pharmacological therapy in the form of 0.12% chlorhexidine digluconate and 400mcg of folic acid tablets, and non-pharmacological therapy in the form of instructions for cleaning teeth and tongue, increase drinking water habit, avoiding hard textured food, and compressing the oral ulcer which must be monitored daily with adherence to the therapy undertaken by the patient, results in improved general conditions, and the ulcer heals on the 13th day.
Keywords: Cyclophosphamide, febrile neutropenia, B-cell lymphoma.
Keywords
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DOI: https://doi.org/10.24198/jkg.v31i3.23838
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