I.

PERJALANAN PENYAKIT

5 days 3 days 1 days

prior to hospital admission prior to hospital admission prior to hospital admission

 Sore throat  Sore throat  Sore throat, low-grade fever

 Gray-white membrane ¾ cover tonsils
 Low-grade fever  Low-grade fever
 Decreased of appetite, eat a little
 Gray-white membrane porridge, decreased of body weight
¼ cover tonsils  Brought to government hospital
 Decreased of appetite  Laboratory check : Hb14.3 g/dL, PLT
217.000/m3, WBC 17.000/mm3, DC
 Just eat a little 0/0/58/34/5%, ESR 45 mm/h, CRP 53,8
porridge mg/dl.
  Reffered to RSMH

1st hospital day 2nd hospital day 3rd and 4th hospital day

 Came to emergency room:  No fever, sore throat decreased, pseudomembran +

 No fever, sore throat
 Sore throat become worse , fever -, gray- released
decreased, pseudomembran
white membrane ¾ tonsils  Treatment : Penicilin Procain (3-4)
+
 Physical Examination  ECG (2) : normal
o Tachycardia  Treatment : Penicilin Procain  Monitor: vital signs, gray pseudomembran
o Tonsil T3-T3, hyperemic, pharynx (2)

o
hyperemic
Gray-white pseudomembrane
 Monitor:vital signs, gray
pseudomembran
 Incomplete immunization
 Laboratory : increased of CRP 90.5
 ECG : sinus tachycardia
 Treatment: isolation room, DAT, Penicillin
procain,
 Probable Diphtheria
 Plan to tonsil swab culture

5th – 7th hospital day 8th and 14th hospital day

 No fever, sore throat -, pseudomembran +  No fever, sore throat -,

disappeared
 ECG (2) : normal ECG (4th hospital day)
 Treatment : Penicilin Procain (5-7)
pseudomembran disappeared
 ECG (3) : normal ECG (10th hospital
day)
 Treatment : Penicilin Procain (8-14)
 Tonsil swab culture : negative
Corynebacterium diphtheria
 Patient was discharged on the 14th
hospital day