PARAMETER TEMUAN LABORATORIUM SEBAGAI PENENTU PERJALANAN PENYAKIT DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS)

RISKA S GALVANI, Prof. Dr. Med. dr. Retno Danarti, Sp.KK(K).; dr. Sri Awalia Febriana, M.Kes, Sp.KK(K), Ph.D

2021 | Tesis-Spesialis | DERMATOLOGI DAN VENEREOLOGI

Latar Belakang: Drug reaction with eosinophilia and systemic symptoms (DRESS) adalah salah satu bentuk Severe cutaneous adverse reactions (SCAR) yang ditandai dengan ruam kulit, keterlibatan multiorgan dan hipereosinofilia. Sindrom DRESS ditandai dengan gejala klinis yang panjang dan berakibat fatal, menyebabkan kematian. Faktor prognostik dapat diidentifikasi untuk mencegah tingkat keparahan penyakit yang berujung pada kematian. Tingkat keparahan penyakit tersebut dapat dinilai melalui durasi gejala klinis. Temuan laboratorium seperti jumlah limfosit, eosinofil dan kadar enzim transaminase hepar telah dilaporkan mempengaruhi durasi gejala klinis sindrom DRESS. Penelitian ini merupakan kajian analitik pertama untuk mengetahui karakteristik kejadian sindrom DRESS di RSUP Dr. Sardjito, Yogyakarta. Tujuan: Mengetahui korelasi antara jumlah limfosit, eosinofil, enzim transaminase hepar dan durasi gejala klinis sindrom DRESS di RSUP Dr. Sardjito, Yogyakarta Metode: Penelitian ini merupakan penelitian retrospektif observasional dengan rancangan studi potong lintang. Penelitian ini dilakukan di Instalasi Catatan Medis RSUP Dr. Sardjito, Yogyakarta pada bulan Januari - Maret 2021, menggunakan data dari rekam medis dan register pasien rawat inap di bangsal bagian Kulit dan Kelamin yang dirawat pada Januari 2016 - Desember 2020. Hasil: Jumlah total subyek penelitian 38 orang. Eritema makulopapular, eksfoliasi, dan eritema klonfluen merupakan jenis lesi kulit terbanyak yang ditemukan pada penderita sindrom DRESS. Eosinofilia dan peningkatan kadar enzim transaminase merupakan kelainan hematologi terbanyak yang ditemukan pada penderita sindrom DRESS. Etiologi terbanyak yang mendasari kasus DRESS adalah obat antibakterial golongan sefalosporin, Terdapat korelasi positif yang signifikan antara jumlah limfosit, eosinofil, kadar enzim transaminase hepar dan durasi gejala klinis sindrom DRESS (p<0,05) Kesimpulan: Terdapat korelasi yang signifikan antara jumlah limfosit, eosinofil kadar enzim transaminase hepar dan durasi gejala klinis sindrom DRESS

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is one of severe cutaneous adverse reactions (SCAR) characterized by skin rashes, multi-organ involvement and hyper eosinophilia. DRESS syndrome is characterized by long-term clinical symptoms and fatal. Prognostic factors for DRESS syndrome can be identified to prevent the severity of the disease leading to death. The severity of the disease can be assessed by the duration of clinical symptom. Laboratory findings such as lymphocyte, eosinophil and hepatic transaminase enzyme levels have been reported to influence the duration of DRESS syndrome. This study is the first analytical study to determine the characteristics of the incidence of DRESS syndrome in Dr. Sardjito hospital, Yogyakarta. Objective: To know the correlation between lymphocytes, eosinophils, liver transaminase enzymes count and the duration of the course of DRESS syndrome in Dr. Sardjito hospital, Yogyakarta. Method: This study is a observational, retrospective with cross sectional study design. This research was conducted at the Dr. Sardjito Hospital Yogyakarta in January - March 2021, using patient medical records and inpatient registers in the Dermatology and Venereology wards from January 2016 to December 2020. Result: The total number of subject in this study was 38 people. Maculopapular erythema, exfoliation, and confluent erythema are the most common types of skin lesions found in patients with DRESS syndrome. Eosinophilia and elevated of the transaminase enzyme levels are the most common hematological disorders found in patients with DRESS syndrome. The most common etiology underlying DRESS is cephalosporin. There is a significant correlation between the number of lymphocyte, eosinophils, liver transaminase enzyme levels and duration of clinical symptoms of DRESS syndrome (p<0.05). Conclusion: There is a significant correlation between the number of lymphocyte, eosinophils, liver transaminase enzyme levels and duration of clinical symptoms of DRESS syndrome.

Kata Kunci : Severe cutaneous adverse reactions, drug reaction with eosinophilia and systemic symptoms, manifestasi klinis, pemeriksaan laboratorium, durasi penyakit, Severe cutaneous adverse reactions, drug reaction with eosinophilia and systemic symptoms, clinical m