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Abstrak

Asma Persisten Sedang, Penyakit Graves, Sirosis Hepatis

Kompensata Dan Ikterus ecDrug induce PTU

Andri Rais, Regan Lesmana S, RM. Dewi*, Yulianto K*, Alwi Shahab*

Divisi Endokrin dan Metabolik, Departement Ilmu Penyakit Dalam

FK UNSRI/RSMH Palembang*

Pendahuluan : Asma merupakan suatu penyakit hipersensitifitas yang ditandai adanya obstruksi

saluran napas reversibel, yang dapat membaik secara spontan atau pengobatan. Penyakit graves

merupakan penyakit autoimun pada tiroid yang ditandai adanya thyrotropin receptor stimulating

antibodies sehingga terjadi tirotoksikosis. Sirosis hepatis merupakan suatu penyakit hati stadium akhir

yang bersifat progresif ditandai dengan fibrosis hati dan nodulus regeneratif. Kasus ini diangkat

karena masalah terapi, dimana terapi penyakit Graves (PTU dan propanolol) dapat memperburuk

penyakit asma bronkial dan sirosis hati, sebaliknya terapi penyakit asma (aminofilin dan salbutamol

oral)) juga dapat memperburuk penyakit Graves.

Laporan Kasus :

Anamnesis. Seorang wanita 28 tahun datang dengan keluhan utama sesak nafas sejak 1 hari SMRS.

Dari perjalanan penyakit, sejak 1 bulan sebelum masuk rumah sakit pasien mengeluh sesak nafas,

terutama saat terkena cuaca dingin dan debu, sesak disertai mengi, ada batuk berdahak putih. Pasien

juga mengeluh tangan sering gemetar, banyak keringat, dan berdebar-debar, berat badan menurun.

Pasien berobat ke rumah sakit dan dikatakan sakit asma dan tiroid, lalu diberi obat PTU dan lainnya

sehingga keluhan berkurang. Sejak 2 minggu sebelum masuk rumah sakit pasien mengeluh mata

menjadi kuning tapi tidak berobat, pasien masih tetap meneruskan minum obat lamanya. Sejak 1

hari sebelum masuk rumah sakit pasien mengeluh sesak napas hebat, disertai mengi, os bicara dengan

kalimat terputus-putus, disertai batuk berdahak putih. Mata kuning makin bertambah bahkan sampai

ke seluruh badan, BAK seperti teh tua. Lalu pasien berobat ke RSMH dan dirawat. Dari riwayat

penyakit dahulu pasien pernah menderita asma sejak 5 tahun yang lalu, Rinitis sejak 6 tahun yanglalu, alergi makanan (ikan laut dan udang). Asma dalam keluarga ada yaitu ibu, nenek dan pamannya.

Pemeriksaan fisik dan penunjang, Data yang mendukung Asma adalah respirasi 30 x/ menit,

ekspirasi memanjang, wheezing ekspirasi, feses rutin normal, spirometri terdapat obstruksi berat,

rontgen toraks normal. Data yang mendukung penyakit Graves adalah Nadi 120 x/menit, reguler,

eksoftalmus, tidak ada struma, indeks wayne 22, T3 1,39 nmol/l, T4 157,4 nmol/l, FT4 1,31 nmol/l,

TSH < 0,005 nmol/l, EKG sinus takikardi, konsul mata tidak ada tanda-tanda eksoftalmus, TRAb 10,9

iu/L (positif). Data yang mendukung Sirosis hati adalah venektasi di abdomen, trombositopenia

(49.000/mm3), HBsAg negatif, Anti HCV negatif, AMA (negatif), USG abdomen terdapat sirosis

hati. Data yang mendukung ikterus ec drug induced PTU (riwayat makan obat PTU bulan, sklera

ikterik, Ikterus (bilirubin total 7,94 mg/dl, direk 4,18 mg/dl, indirek 3,56 mg/dl), SGOT 50 u/l, SGPT

26 u/l, LDH 719 U/l, GGT 32 u/L, alkali fosfatase 132 u/L, ikterus membaik setelah PTU distop

(bilirubin total 3,54 mg/dl, direk 2,02 mg/dl, indirek 1,52 mg/dl.

Kesimpulan. Pasien didiagnosis dengan asma persisten sedang, penyakit Graves, sirosis hepatis

kompensata, dan Ikterus ec drug unduced PTU, yang ditatalaksana dengan stop PTU (diganti dengan

metimazole tab 1x10 mg), ventolin inhaler 200 mcg (jika sesak), budenoside inhaler 3 x 200 mcg, dan

digoksin 1 x 0,125 mg.

Kata kunci: Asma persisten sedang, Graves disease, Sirosis hepatis, ikterus.

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Abstract

Moderate Persistent Asthma, Grave's Disease, Compensated liver

cirrhosis, And Icteric ec Drug Induced PTU

Andri Rais, Regan Lesmana S, RM. Dewi, Yulianto K, Alwi Shahab*

Endocrine and Metabolic Division, Department of Medicine

FK UNSRI / RSMH Palembang*

Introduction. Asthma is a hypersensitivity disease characterized by reversible airway obstruction,

that may resolve spontaneously or treatment. Graves Disease is an autoimmune disease characterized

by thyrotropin receptor stimulating antibodies that cause thyrotoxicosis. Hepatic cirrhosis is an end-

stage liver disease progressively that is characterized by liver fibrosis and regenerative nodules. This

case is very interesting because there is a treatment problem, some drugs for Graves disease (PTU

and propanolol) can worsen bronchial asthma and hepatic cirrhosis condition, conversely drugs for

brochial asthma (oral aminofilin and salbutamol) can worsen Graves disease condition.

Case Report :

Anamnesa. A 28 years old woman comes with a chief complaint of shortness of breath since 1 day

before entering the hospital. From the course of disease, since 1 months before entering the hospital

the patient complained of shortness of breath, especially when exposed to cold weather and dust, also

accompanied by wheezing, cough with white phlegm. Patients also complain of frequent hand

shaking, a lot of sweat, and palpitations, weight loss. Patients treated at the hospital and said to

asthma and thyroid, then the patient is given PTU drug and others that grievance is reduced. Since 2

weeks before entering the hospital the patient complained of the eyes become yellow but did not seek

treatment, patients still continue taking medication ever. Since 1 day before entering the hospital the

patient complained of severe shortness of breath, also accompanied by wheezing, patient speak withdisjointed sentences, coughing with white phlegm. Yellow eyes growing even to the body, old tea-

colored urine. Then the patient went to RSMH and treated. From the history of the disease before the

patient suffered from asthma since 5 years ago, rhinitis since 6 years ago, there was a food allergy

(fish and shrimp). His family have asthma to (mother, grandmother and uncle).

Physical and additional examination, supporting data to bronchial asthma are respiratory rate 30

bpm, lengthening expiration, expiratory wheezing, routine stool is normal, there is a severe

obstruction from spirometry, chest X-ray is normal. The data support to Grave's disease are pulse 120

bpm, regular, eksoftalmus, no goitre, wayne index is 22, T3 level 1.39 nmol/l, T4 level 157.4 nmol/l,

FT4 level 1.31 nmol/l, TSH level < 0.005 nmol/l, ECG is sinus tachycardia, no signs of exopthalmus

according to opthalmologist, TRAb level 10.9 IU/L (positive). The data support to liver Cirrhosis are

abdomen venectasy, thrombocytopenia (49.000/mm3), HBsAg is negative, Anti HCV is negative,AMA is negative, there is liver cirrhosis from abdominal ultrasound. The data support to icteric ec

drug induced PTU are medication history of PTU since months before, icteric schlera, icteric (total

bilirubin 7.94 mg/dl, direct 4.18 mg/dl, indirect 3.56 mg/dl), AST 50 U/L, ALT 26 U/L, LDH 719

U/L, GGT 32 U/L, alkaline phosphatase 132 U/L, icteric improved after PTU was stopped (total

bilirubin 3.54 mg/dl, direct 2.02 mg/dl , indirect 1.52 mg/dl.

Conclusion. Patients diagnosed with moderate persistent asthma, Grave's disease, compensated liver

cirrhosis, and icteric ec drug unduced PTU, which is treated by stop PTU (replaced by metimazole tab

once daily), Ventolin inhaler 200 mcg (if crowded), budenoside inhalers 200 mcg three times daily,

and digoxin 0.125 mg once daily.

Keywords. Moderate Persistent Asthma, Grave's Disease, Compensated Hepatic Cirrhosis, Icteric.

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