A. Ayu Hafsari.

M
Ahmad Wahyuddin
Idham Djamaluddin
 PATIENT IDENTITY
• Name : Mr. AK
• Gender : Male
• Age : 70 years old
• Marital status : Marriage
• Religion : Moslem
• Address : BTN. Samata B2
• Job : Pensionary
• Addmission date : 21/02/2012
• Medical record no : 293854
 History Taking
• Chief Complaint: Vesicle
• Brief anemnesis: since ±3 days ago in the face,
vesicle appear slightly and into multiply. Vesicle
spread and become pustule then broken into the
crust. Edema (+), pain (+), Itchy (+), febris (-), cough
(-), Dyspneu (-), vomitting (-), nausea (-), the patient
can’t sleep. He couldn’t eat just drink. History of
contact with people with varicella 1 month ago.
• family history with the same disease (-), history of
allergy (-), history of medication : Acyclovir
5x200mg/day and Acyclovir 5% 5gr. History of
Tuberculosis (+), DM (-), HT (-).
CURRENT STATUS
• Consciousness : Compos Mentis
• General Condition : Moderate
• Hygiene : Moderate
• Nutrition : Less
• Vital sign BP : 110/60 mmHg
Pulse: 90x/minutes
RR : 18x/minutes
Temperature: 370C
 PHYSICAL EXAMINATION

• Anemic (-), icterus (-), cyanoses (-)

• Cor/ Pulmonal: Normal
• Abdomen: Normal, peristaltic (+)
• Extremities: Edema (-)
• Lymph nodes: Enlargement (-)
DERMATO-
VENEROLOGY STATUS
• Regio : Regio Fascialis and Regio
Pallatum
• Efl : vesicles clustered on the
basis of erythema, crust,
pustule, edema, pustule
clustered on the basis of
erythema.
 Laboratory Result
• Ureum : 25 mg/dl
• Creatine : 15 mg/dl
• GDS : - mg/dl
• SGOT : 15 U/I
• SGPT : 5 U/I
• WBC : 5.3 (10 3 /uL)
• RBC : - (10 6 /uL)
• HB : 13,6 (g/dL)
• HCT : - (%)
• PLT : 196 (10 3 /uL)
RESUME
• Mrs. F came to hospital with vesicle since ±3 days ago in the
face, vesicle appear slightly and into multiply. Vesicle spread
and become pustule then broken into the crust. Edema (+),
pain (+), Itchy (+), febris (-). The patient can’t sleep. He
couldn’t eat just drink. History of contact with people with
varicella 1 month ago.
• History of medication : Acyclovir 5x200mg/day and Acyclovir
5% 5gr. History of Tuberculosis (+). His diagnosis is Herpes
Zoster Opthalmicus Sinister.
• Physical examination: Moderate
• Dermato-venerology
Regio : Regio Fascialis and Regio Pallatum
Efl : vesicles clustered on the basis of erythema,
crust, pustule, edema, pustule clustered on the
basis of erythema.
DIFFERENTIAL DIAGNOSIS
DIAGNOSIS
Herpes Zoster Oftamicus (S)
 DISCUSSION
Herpes zoster is a disease caused by infection with varicella-
zoster virus attacks skin and mucous. This is the reactivity of
virus infection that occurs after a viral infection. Ophthalmic
herpes zoster is caused by infection with the first branch of
the trigeminal nerve, and giving rise to abnormalities in the
eye. Besides that the second and third branch causes
abnormalities in the skin and nerves. before the skin
symptoms, prodromal symptoms are either systemic or local.
after the onset of erythema, in a short time become vesicles
that clustered on the basis of skin eritmatosa and edema.
These vesicles contain clear fluid and then into pustules and
crusting.
RECOMMENDED EXAMINATION

• Tzanck Test
TREATMENT & MANAGEMENT

• Acyclovir 400mg 5x1/day

• Tramadol 50mg 2x1/ day
• Amitriptilin 12,5 0-0-1/day
• Methylprednisolon 4mg 4x4x4/day
• Neurodex 1-1-0
• Acyclovir cream 5gr
• Fuson cream 5gr
PROGNOSIS
• Good (Bonam)
HERPES ZOSTER
DEFINISI
• Diseases caused by the varicella-zoster
• Virus infection of skin and mucous
• Attacking virus reactivation is occurring
after a primary infection
Sinonim
• Dampa
• Smallpox snake
Epidemiologi
• The distribution is the same as varicella
• Reactivation of the virus occurs after
patient get varicella
• Sometimes it lasts a subclinical varicella
• Aerogen virus transmission from varicella
patients
Patogenesis
• The virus is found in the ganglion posterior
edge of the nervous system and cranial
ganglion
• Abnormality → level of regional
abnormalities in the neural ganglion
• Sometimes invade the anterior ganglion
motor disorders → motoric disorder
Gejala klinis
1. predilection →thoracic (often) → other
areas could be affected
2. frequency → male = female
3.Age → Adults (often)
prodromal symptoms
Systemic: fever, headache, malaise
Local: muscle-skeletal pain, itching, sore
• Gejala kulit :
1. Eritem → cepat menjadi vesikel
berkelompok, dasar kulit eritematosa
dan edema
Vesikel (berisi cairan jernih)→ Keruh →
Pustul → Krusta
Infeksi sekunder→ulkus→penyembuhan
dengan sikatriks
2. Pembesaran Kelenjar Getah Bening
3. Lokalisasi → Unilateral
4. Hiperestesi pada daerah yang terkena
5. Neuralgia pasca herpetik : Nyeri timbul
pada daerah bekas penyembuhan →
bisa berbulan2 atau bertahun2
Manifestasi klinis herpes zoster
1. Herpes zoster oftalmikus
Infeksi → cabang pertama
N.Trigeminus→ Kelainan pada mata
Infeksi→cabang dua dan tiga →timbul
kelainan pada daerah saraf yang
terkena.
Sindrom Ramsay Hunt →gangguan
N.Facialis, N.Otikus → gejala paralisis otot
muka (paralisis Bell)
Kelainan kulit sesuai tingkat persarafan,
tinitus, vertigo, gangguan perdengaran,
nistagmus, nausea, gangguan
pengecapan
2. Herpes zoster abortif
Berlangsung singkat, hanya berupa vesikel dan eritem
3 Herpes zoster generalisata
Kelainan kulit unilateral dan segmental + kelainan kulit
generalisata : vesikel soliter dan umbilikasi
Pada orang dengan kondisi fisik lemah
Komplikasi
1. Neuralgia pasca herpetik (umur > 40
thn)
2. Ptosis paralitik
3. Keratitis
4. Skleritis
5. Uveitis
6. Korioretinitis
7. Neuritis optik
Diagnosis
1. Anamnesa
2. Pemeriksaan dermatologis
3. Pemeriksaan penunjang → Tzanck Test
→ Sel datia berinti banyak → positif
Diagnosis Banding
1. Herpes simpleks
2. Nyeri → penyakit reumatik, angina
pectoris
Pengobatan
• Terapi sistemik :
1. Analgetik
2. Antibiotik
3. Antivirus
→ Acyclovir 5 x 800 mg/hari (7 hari)
→ Valacyclovir 3 x 1000 mg/hari
4. Imunostimulator → Isoprinosin
• Terapi topikal :
Vesikel → bedak (mencegah infeksi
sekunder)
Erosif → Kompres terbuka
Ulserasi → Salep Anti Biotik