Indonesian Journal of Case Reports

Malignant Syphilis in HIV: A Diagnostic and Management Challenge

Senduk Cindy Regina, Nurdjannah Jane Niode — Wed, 05 Mar 2025 00:00:00 +0700

Malignant syphilis is a rare and severe form of secondary syphilis, often seen in immunocompromised individuals, including those with advanced HIV infection. We report a 29-year-old male with newly diagnosed Stage IV HIV who presented with widespread erythematous plaques and scales and systemic symptoms. Dermatological examination revealed generalized erythematous macules and plaques with scaling, erosion, and crusting. Ulcerative lesions with crusts were noted on the toes and soles. Venereological findings included erythematous to skin-colored macules on the scrotal and penile areas. Serological tests revealed high VDRL (1:128) and TPHA (>1:5120) titers, and histopathology confirmed secondary syphilis. The patient was treated with intramuscular benzathine penicillin G (2.4 million units) weekly for three weeks in conjunction with antiretroviral therapy (ART). Although the patient experienced a Jarisch-Herxheimer reaction, there was significant clinical and serological improvement, with a fourfold reduction in VDRL titers after nine months. This case emphasizes the need for early recognition of malignant syphilis in immunocompromised patients and highlights the effectiveness of benzathine penicillin G and ART in treatment. Regular follow-up is essential to monitor progress and prevent recurrence.

Managing an Atypical Case of Pediatric Cutaneous Polyarteritis Nodosa: Clinical Perspectives Managing Rare Presentation of Cutaneous Polyarteritis Nodosa in Pediatric Patient: Insight from a Case Study

Adelia Anggraini Utama, Priyanti Kisworini, Niarsari Anugrahing Putri — Sat, 12 Apr 2025 00:00:00 +0700

Cutaneous polyarteritis nodosa is a rare form of necrotizing vasculitis affecting small and medium-sized arteries, characterized by localized inflammation and ischemia without systemic organ involvement. This case report highlights a 7-year-old girl who presented with severe cutaneous manifestations, including digital necrosis and livedo reticularis, accompanied by arthralgia and myalgia. Laboratory findings revealed elevated inflammatory markers and a high anti-streptolysin O titer, indicating a possible post-streptococcal etiology. Angiographic evidence confirmed arterial occlusion in the left hand. The patient was treated with high-dose intravenous methylprednisolone, anticoagulation, and long-term methotrexate, resulting in symptom resolution and sustained remission over one year. This case emphasized the importance of prompt recognition, diagnosis, and multidisciplinary management of cutaneous polyarteritis nodosa to prevent and improve outcomes.

Coexistence of Psoriasis Vulgaris and Systemic Lupus Erythematosus: A Rare Clinical Case

Thu, 24 Apr 2025 00:00:00 +0700

Psoriasis vulgaris is a chronic skin inflammation characterized by the appearance of clearly limited erythematous plaques, along with rough, thick, and silvery-white scales. Systemic Lupus Erythematosus (SLE) is a multifactorial autoimmune disease with diverse clinical manifestations and can involve one or more organs. This case report presents a patient with Psoriasis Vulgaris with SLE. A 47-year-old woman presented with erythematous plaque lesions with thick scales and some hyperpigmentation, numerous, plaque-sized lesions with regional distribution on the scalp, right and left cubital areas, gluteal, left tibia, and yellow unguium dyschromia was seen on the distal lateral aspect, solitary on the right 3rd digit. Histopathological examination found typical Psoriasis Vulgaris. The patient was diagnosed with Psoriasis Vulgaris. In 2022, the patient was diagnosed with SLE and received Hydroxychloroquine sulfate therapy. The patient was treated with a combination therapy including methotrexate (MTX) and topical medications. This case highlights the importance of comprehensive evaluation for Psoriasis Vulgaris therapy with a previous history of SLE and the choice of treatment in patients with the coexistence of PV and SLE.

Hope After Cancer: Pregnancy Outcomes Following Fertility-Sparing Surgery – A Case Report

Wed, 04 Jun 2025 00:00:00 +0700

Pregnancy after diagnosis of ovarian cancer is a rare event. Ovarian Cancer is associated with difficulty in achieving pregnancy. Little is known about the mechanism of this condition due to limited literature and studies. In this paper, the authors report a rare case of successful pregnancy in a patient with ovarian cancer. Patient initially diagnosed with cystadenocarcinoma mucinous of the ovary, two years prior to pregnancy, and later diagnosed with suspected ovarian cancer in the third trimester. The patient was then treated with optimal debulking surgery and cesarean section at 35 weeks of pregnancy. The patient delivered a healthy baby girl. Debulking surgery was carried out, and the patient was scheduled for chemotherapy. The findings from this case conclude that patients with ovarian cancer who receive conservative surgical treatment could have successful pregnancy outcomes. The quality of the patient’s life should be a priority, and follow-up for further treatment is essential.

Early Intervention in Unilateral Retinoblastoma: A 2-Year-Old’s Journey Through Enucleation and Evidence-Based Care

Eva Imelda, Sarra Mutiara Adev, Siti Rain Jannah, Nikhil Toshniwal — Fri, 13 Jun 2025 00:00:00 +0700

Retinoblastoma is a neoplasm that arises from the retina and is frequently observed in pediatric patients, with a high degree of morbidity, particularly in underdeveloped nations. The classification of this tumor is based on its spread (intraocular and extraocular) and location (unilateral, bilateral, trilateral, and quadrilateral). Unilateral retinoblastoma is the most prevalent form, accounting for 60–70% of cases. A 2-year-old female patient was brought to the Eye Clinic of the Pediatric and Strabismus Department of Dr. Zainoel Abidin Regional Hospital by her parents with a complaint of a white spot in the center of her left eye, accompanied by decreased visual acuity for 3 months. A subsequent examination, using ultrasound (USG), revealed a mass at the base of the retina, accompanied by calcification and infiltration into the vitreous. An orbital scan revealed intraocular calcification, exclusively in the left eye. The patient was diagnosed with unilateral leukocoria OS et causa retinoblastoma grade E. Subsequent treatment plans included OS enucleation and EUA (Examination Under Anesthesia) procedures. Following the EUA procedure, no mass was identified in the right eye. An anatomical pathology examination revealed no spread to the optic nerve; therefore, chemotherapy was not given.