Suplementasi mikronutrien pada pasien eritema multiforme dengan penurunan kualitas eritrosit  Micronutrient supplementation in erythema multiforme patients with decreased erythrocyte quality

I Nyoman Gede Juwita Putra; Suniti Suniti; Nanan Nur'aeny; Indah Suasani Wahyuni

doi:10.24198/jkg.v32i3.31871

Suplementasi mikronutrien pada pasien eritema multiforme dengan penurunan kualitas eritrosit
Micronutrient supplementation in erythema multiforme patients with decreased erythrocyte quality

I Nyoman Gede Juwita Putra, Suniti Suniti, Nanan Nur'aeny, Indah Suasani Wahyuni

Abstract

Pendahuluan: Eritema multiforme (EM) adalah penyakit peradangan akut yang merupakan reaksi hipersensitivitas pada mukokutan dan jarang ditemukan. Gambaran klinis EM berupa lesi erosi-ulseratif dan memiliki tendensi perdarahan. Kualitas eritrosit yang menurun dapat mempengaruhi proses penyembuhan penyakit ini, namun hal ini dapat diatasi dengan pemenuhan asupan mikronutrien. Tujuan laporan kasus ini untuk memaparkan hasil terapi suplementasi mikronutrien yang diberikan untuk tatalaksana EM pada pasien yang mengalami penurunan kualitas eritrosit. Laporan kasus: Seorang wanita berusia 21 tahun mengeluhkan perdarahan bibir dan sariawan dalam rongga mulut, terasa sakit sejak 3 minggu sebelumnya. Riwayat keluhan yang sama pernah dialami 7 tahun sebelumnya. Pemeriksaan ekstraoral memperlihatkan krusta hemoragik pada bibir, sedangkan hasil pemeriksaan intraoral menunjukkan ulserasi multipel pada hampir seluruh mukosa rongga mulut. Hasil pemeriksaan laboratorium menunjukkan adanya penurunan kualitas eritrosit berdasarkan parameter Mean Corpuscular Volume (MCV), Mean Cell Hemoglobin (MCH), dan Mean Cell Hemoglobin Concentration (MCHC); peningkatan jumlah eritrosit; dan eosinofil pada borderline atas, serta anti HSV-I IgG non-reaktif. Diagnosis pasien adalah eritema multiforme dengan riwayat stomatitis aftosa rekuren (SAR). Tatalaksana farmakologis diberikan asam folat dan vitamin B₁₂ sebagai suplementasi mikronutrien. Diberikan pula chlorhexidine digluconate 0,12% mouthrinse sebagai antiseptik, dan petroleum jelly untuk pelembab bibir. Lesi oral pasien sembuh setelah 2 minggu terapi. Simpulan: Suplementasi mikronutrien berperan penting dalam mempercepat penyembuhan lesi mukosa oral pada pasien eritema multiforme yang mengalami penurunan kualitas eritrosit. Mikronutrien berupa asam folat dan vitamin B₁₂ berperan penting dalam sintesis DNA eritrosit, pembelahan sel, dan perbaikan jaringan.

Kata kunci: Mikronutrien, eritema multiforme, kualitas eritrosit.

ABSTRACT

Introduction: Erythema multiforme (EM) is an acute inflammatory disease as a hypersensitivity reaction to mucocutaneous and is rarely found. The clinical feature of EM is an erosive-ulcerative lesion with a tendency of bleeding. Decreasing erythrocyte quality can affect its healing process, although able to be overcome by fulfilling the micronutrient intake. The purpose of this case report was to describe the results of micronutrient supplementation therapy given in the management of EM patients with decreasing erythrocyte quality. Case report: A 21-year-old woman complained of lip bleeding and oral thrush, which felt pain three weeks prior. A similar complaint history had been experienced in the previous seven years. Extraoral examination revealed haemorrhagic crusting on the lips, whereas intraoral examination showed multiple ulcerations of almost the entire oral mucosa. Laboratory examination results showed a decreasing erythrocyte quality based on the parameters of Mean Corpuscular Volume (MCV), Mean Cell Haemoglobin (MCH), and Mean Cell Haemoglobin Concentration (MCHC); an increasing number of erythrocytes and eosinophils in the upper borderline, as well as non-reactive anti-HSV-I IgG. The patient was diagnosed with erythema multiforme with a history of recurrent aphthous stomatitis (RAS). Pharmacological management was performed by given folic acid and vitamin B12 as micronutrient supplementation. Also, given a 0.12% chlorhexidine digluconate mouth rinse as an antiseptic and petroleum jelly for lip balm. The patient’s oral lesions resolved after two weeks of therapy. Conclusion: Micronutrient supplementation plays an essential role in accelerating the oral mucosal lesions healing in erythema multiforme patients with decreasing erythrocyte quality. Micronutrients in folic acid and vitamin B12 play an important role in erythrocyte DNA synthesis, cell division, and tissue repair.

Keywords: Micronutrient, erythema multiforme, erythrocyte quality.

Keywords

mikronutrien; eritema multiforme; kualitas eritrosit; micronutrient; erythema multiforme; erythrocyte quality

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DOI: https://doi.org/10.24198/jkg.v32i3.31871