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Case Report A 19 year-old girl was come to Dermato-Venereology outpatient Department of Dr. M.

Djamil Hospital Padang on September 4th 2008, with: Chief Complaint There were white patch with decreased of sensation on both of her lower leg since 3, months ago. Present illness history There were white patch with loss of sensation on both of her lower leg since 3 months ago. Initially, about 3 years ago there were white patches with decreased of sensation on the back side of left lower leg. The patches were increased in size and spread to the front side left lower leg and to the back side of right lower leg in last three years. The patches were not itchy, dry and covered by fine scales. Her sister had disease like this about 8 years ago, the patient life in the same house with her sister. There was no history of patches became reddish and thickness during last three years followed by fever, joints pain and fatigue. There was hair loss on the white patches. There was no history of hair loss on the eye brow. There was no history of tenderness of the finger. There was no history of ulcer on the foot. There was no history of wounds or other skin diseases on the affected area Previous illness history She got BCG vaccination when he was baby She had white patches with decrease of sensation in the back side of left lower leg on December 2005 and went to dermatologist examined Acid Fast Bacilli (AFB) with negative result and then got green package of medicines (MDT-PB) for six month routinely. The white patches and decreased of sensation became smaller then drug was stop. Three month after finished therapy (August 2006) white patches with loss of sensation on left lower leg became larger and appeared new smaller white patches with decreased of sensation on front side of left lower leg. The patch slowly increased in size. Then patient got MDT-PB again for six month routinely. The white patches and decreased of sensation became smaller then drug was stop. On early 2007 white patches with loss of sensation on left lower leg became larger and appeared new white patches with loss of sensation on back side of right lower leg. The patch slowly increased in size. There were no fever, pain on joints, fatigue accompanied. Then patient got MDT-PB again for six month but no improvement. Family illness history Her little sister suffered the same disease about 8 years ago, and got blue package of medicine (MDT-PB for children) regularly from Public Health Centre for six month and cure and never relapse.

Socio-economic history She lived in Padang since she was born. Both of her parents were from Pariaman She has middle economic standard living. Dermatologic state Location : back side of both lower legs, front side of right lower leg Distribution : localized Shape/arrangement : unspecific Border : well defined - undefined Size : lenticular to plaque Efflorescent : hypo pigmented macula, with fine scales Sensibility examination Pinprick : hypoesthesia on the lesions Light touch : hypoesthesia on the lesions Temperature : hypoesthesia on the lesions Motoric examination m. orbicularis occuli : 5 m. abductor digiti minimi : 5 m. interoseous dorsalis : 5 m. abductor pollicis brevis : 5 m. tibialis anterior : 5 Peripheral nerves examination N. auricularis magnus N. ulnaris N. perenous lateral N. dorsalis pedis Autonomic examination: Anhidrosis Alopecia Other abnormalities Madarosis Facies leonina Ulcer Absorption Mutilation Contracture Xerosis cutis Atrofi Split skin smear Acid fast bacilli examination Left earlobe : no enlargement : no enlargement : no enlargement : no enlargement : cannot be examined : present on the lesion : none : none : none : none : none : none : minimal on the lesion : none

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Right earlobe Lesion on right lower leg Lesion on left lower leg

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Working Diagnosis Borderline tuberculoid type leprosy relapses. Differential Diagnosis Borderline tuberculoid type leprosy with late reversal reaction Suggestion Skin biopsy Hematology and blood chemistry Inoculation M.leprae on mouse footpad General Treatment Explain about the disease ; etiology, the course, complication, and transmission of the disease and possibility of reaction on the course of the disease Observation of the lesions Prognosis Quo ad vitam Quo ad sanam Quo ad cosmeticum Quo ad functionam : bonam : bonam : bonam : bonam

Seorang pasien Laki-laki, umur 8 bulan, dibawa ibunya ke Poliklinik Kulit dan Kelamin RSUP dr. M. Djamil Padang dengan: KELUHAN UTAMA : Keropeng berwarna kekuningan di hidung dan di pertengahan hidung-mulut sejak 4 hari yang lalu. RIWAYAT PENYAKIT SEKARANG Keropeng berwarna kekuningan di hidung dan di pertengahan hidung-mulut sejak 4 hari yang lalu. Awalnya, 5 hari sebelum timbul keropeng di hidung, pada bagian bawah hidung terdapat luka lecet sebesar biji jagung. Kemudian timbul bercak kemerahan disekitar luka lecet dan lama kelamaan menjadi gelembung berisi cairan. Gelembung pecah mengeluarkan cairan berwarna kekuningan yang segera mengering dan muncul gelembung-gelembung kecil berisi air di sekitar hidung, dagu dan bawah mata anak. Pasien sering terlihat menggesek-gesekkan hidung pada badan ibunya bila digendong hingga gelembung-gelembung berisi air tadi pecah

Pasien sedang belajar merangkak. Menurut ibu pasien, lecet tersebut mungkin didapatkan sewaktu jatuh saat sedang merangkak. Sebelum ini pasien ada demam dan batuk kurang lebih 1 minggu yang lalu. Kakak perempuan pasien menderita batuk pilek kurang lebih 10 hari yang lalu. Kakak perempuan pasien sering bermain dengan pasien. Pasien mandi 2 kali sehari dan berganti pakaian 4 kali sehari. Pasien malas makan sejak demam. Pasien sudah dibawa berobat ke puskesmas dan mendapat obat puyer 1 macam. Puyer tersebut cuma dimakan 1 kali saja dan tidak ada perbaikan. Pasien kemudian dibawa ke poliklinik RSUP Dr. M.Djamil Padang. RIWAYAT PENYAKIT DAHULU Pasien tidak pernah menderita penyakit seperti ini sebelumnya. RIWAYAT PENYAKIT KELUARGA/RIWAYAT ATOPI/RIWAYAT ALERGI Tidak ada anggota keluarga yang menderita sakit seperti ini. : hidung, batas antara hidung dan mulut, dagu, bawah mata kiri, atas dan bawah mata kanan. Distribusi : Terlokalisir Bentuk : Bulat tidak khas Susunan : Tidak khas Batas : Tegas Ukuran : Milier sampai numular Efloresensi : papul eritem, makula eritem, vesikel, krusta kehitaman, krusta berwarna kuning madu, erosi PEMERIKSAAN LABORATORIUM Darah : Tidak dilakukan pemeriksaan. Jika dilakukan pemeriksaan darah diharapkan leukositosis Urin : Tidak dilakukan pemeriksaan Feses : Tidak dilakukan pemeriksaan PEMERIKSAAN ANJURAN Kultur dan tes sensitivitas Lokasi