Necrotizing ulcerative stomatitis mimicking erythema multiforme pada pasien dengan HIV seronegatifNecrotizing ulcerative stomatitis mimicking erythema multiforme in HIV seronegative patients

Abstract

ABSTRAK

Pendahuluan: Necrotizing ulcerative stomatitis (NUS) merupakan inflamasi akut yang ditandai destruksi, ulserasi serta nekrosis epitel, jaringan ikat dan papila. Umumnya terjadi pada pasien malnutrisi dan Human Immunodeficiency Virus (HIV) seropositif. Lesi awal berupa necrotizing gingivitis kemudian berkembang menjadi necrotizing periodontitis, selanjutnya menjadi NUS. Gambaran klinis kasus NUS kadang serupa dengan Erythema multiforme (EM), sehingga perlu dilakukan pemeriksaan penunjang yang dapat menegakkan diagnosa dengan tepat. Tujuan laporan kasus ini melaporkan cara menegakkan diagnosis NUS yang menyerupai EM secara tepat pada pasien dengan suspek infeksi HIV. Laporan kasus: Pasien laki-laki berusia 49 tahun dirujuk ke departemen Ilmu Penyakit Mulut dengan diagnosis EM disertai suspek terinfeksi HIV. Keluhan utama berupa rasa nyeri disertai sariawan pada lidah dan bibir bagian dalam. Pemeriksaan ekstraoral tidak ada kelainan, pada intraoral ditemukan ulser multipel dilapisi sloughing kekuningan pada mukosa labial, mukosa bukal, dorsal lidah, lateral lidah dan ventral lidah. Gingiva anterior rahang bawah terdapat lesi ulseratif disertai jaringan nekrosis. Pemeriksaan darah menunjukkan penurunan hematokrit, peningkatan leukosit, serta negatif pada pemeriksaan tes HIV. Actinomyces naeslundii ditemukan pada pemeriksaan mikrobiologi. Ditegakkan diagnosis NUS dan terapi yang diberikan amoxicillin 500mg, metronidazol 500mg, chlorhexidine gluconate 0,2% dan asam folat. Lesi oral mengalami perbaikan dalam 2 minggu. Simpulan: Lesi oral mengalami perbaikan secara signifikan setelah kontrol ketiga atau seminggu dari kunjungan pertama, pasien sudah dapat makan tanpa rasa nyeri. Gambaran klinis lesi mukosa oral yang khas, serta pemeriksaan penunjang mikrobiologi berperan dalam menunjang diagnosis NUS. Tes HIV perlu dilakukan untuk mengkonfirmasi status infeksi HIV pada pasien. Dokter gigi sebaiknya mengenali tanda dan gejala NUS, sehingga dapat menegakkan diagnosis dan memberikan terapi adekuat serta mencegah meluasnya kerusakan jaringan.

Kata kunci: Human immunodeficiency virus, lesi oral, necrotizing ulcerative stomatitis, erythema multiforme.

ABSTRACT

Introduction: Necrotizing ulcerative stomatitis (NUS) is an acute inflammation characterised by destruction, ulceration, and necrosis of the epithelium, connective tissue, and papillae. Generally occurs in malnourished and Human Immunodeficiency Virus (HIV) seropositive patients. The initial lesion is found in the form of necrotizing gingivitis then developed into necrotizing periodontitis, which later became NUS. The clinical feature of NUS sometimes similar to the erythema multiforme (EM); thus, it is necessary to conduct investigations to make the diagnosis correctly. This case report was aimed to report on how to properly diagnose an EM-like NUS in a patient with suspected HIV infection. Case report: A 49-years-old male patient referred to the Oral Medicine department with an EM diagnosis with suspected HIV infection. The main complaint is pain accompanied by mouth sores on the tongue and inner lips part. Extraoral examination showed no abnormality, multiple ulcers coated with yellowish sloughing on the labial mucosa, buccal mucosa, dorsal tongue, lateral tongue, and ventral tongue. The anterior mandibular gingiva had ulcerative lesions with tissue necrosis. Blood tests showed a decrease in hematocrit, an increase in leukocytes, and a negative result of the HIV test. Actinomyces naeslundii was found on microbiological examination. Diagnosis of NUS was confirmed, and therapy given were amoxicillin 500 mg, metronidazole 500 mg, chlorhexidine gluconate 0.2%, and folic acid. The oral lesions improved within two weeks. Conclusion: Oral lesions improved significantly after the third control in a week from the first visit, the patient was able to eat without pain. The clinical feature of typical oral mucosal lesions, as well as microbiological examinations, play a role in supporting the diagnosis of NUS. An HIV test needs to be carried out to confirm the HIV infection status of the patient. Dentists should recognise the signs and symptoms of NUS to determine a diagnosis, provide adequate therapy, and prevent the spread of tissue damage.

Keywords: Human immunodeficiency virus, oral lesions, necrotizing ulcerative stomatitis, erythema multiforme.