Fast Track: A Case Report: Abses Pelvis Pada Pasien Spondilitis Tuberculosis Post Operasi Dan Tuberkulosis Paru Bakteriologis Dalam Pengobatan Obat Anti Tuberkulosis

Jamaluddin - Madolangan

Abstract


Backgroud: Tuberculosis (TB) is an infectious disease caused by infection with the Mycobacterium tuberculosis complex which, with the aid of the lymphatic system and blood vessels, can spread to distant tissues and organs such as lymph nodes, lung apices, kidneys, brain, and bones. In the spine, it causes spinal tuberculosis, also known as Pott's disease. Further spread of spinal tuberculosis can lead to psoas abscess and pelvic abscess, though not all pelvic and psoas abscesses are caused by Mycobacterium tuberculosis; they can also be caused by non-tuberculous bacteria. Objective: To discuss a case of pelvic abscess in a patient with post operative spondylitis tuberculosis and pulmonary tuberculosis bacteriologically confirmed who was undergoing treatment with anti-tuberculosis drugs (ATD). Methods: Case report, Case selected from rare patient cases which are dangerous complications for patients with spondylitis and pulmonary tuberculosis in the hospital ward and evaluated until go home. Results: A 19-year-old woman presenting with pain in the left hip that initially appeared swollen like a boil and then enlarged. The patient has a history of chronic cough and has been taking 2 tablets of FDC (Fixed Dose Combination) anti-tuberculosis drugs daily for the past 8 months, as well as a history of lower back swelling. She underwent decompression surgery and posterior stabilization of lumbar vertebrae II-V due to damage to lumbar vertebrae IV-V, followed by a second surgery due to the appearance of a lump after the previous operation. Vital signs examination revealed fever and underweight nutritional status, while abdominal physical examination showed a purulent wound in the left pelvic region measuring 4x4 cm, with surrounding hyperemia. Laboratory results indicated leukocytosis and anemia, while the Xpert MTB/RIF test of pus from the pelvis showed MTB Not Detected. The patient received Category 1 ATD therapy, abscess drainage, and broad-spectrum antibiotic therapy with imipenem. Post-treatment evaluation showed clinical improvement. Conclusion: Pelvic abscesses can occur due to tuberculosis or non-tuberculosis. Pelvic abscess caused by TB as in this case requires ATD therapy, antibiotics and rapid drainage of the abscess so that the prognosis is good.

Keywords:pulmonary tuberculosis; spondylitis; pelvic abscess

 

ABSTRAK

 

Latar Belakang: Tuberkulosis (TB) adalah penyakit menular yang disebabkan oleh infeksi Mycobacterium tuberculosis complex yang dengan bantuan sistem limfatik dan pembuluh darah, dapat tersebar ke jaringan dan organ yang lebih jauh misalnya kelenjar limfatik, apeks paru, ginjal, otak, dan tulang. Pada tulang belakang menyebabkan spondilitis tuberculosis yang juga dikenal sebagai penyakit Pott atau Pott disease. Penyebaran lebih lanjut dari tuberkulosis tulang belakang dapat menyebabkan abses psoas dan abses pelvis, namun tidak semua abses pelvis dan psoas disebabkan Mycobacterium tuberculosis tetapi juga dapat disebabkan oleh non tuberkulosis. Tujuan: Mendiskusikan kasus abses pelvis pada pasien spondilitis TB post operasi dan TB paru terkonfrimasi bakteriologi sementara pengobatan obat anti tuberkulosis (OAT). Metode: Laporan kasus, kasus diambil dari kasus pasien yang jarang terjadi yang merupakan komplikasi yang membahayakan bagi pasien TB spondylitis dan TB paru dibangsal rumah sakit dan evaluasi sampai pulang. Hasil: Seorang perempuan berusia 19 tahun dengan keluhan nyeri pada pinggul kiri yang awalnya bengkak seperti bisul dan kemudian membesar. Pasien memiliki riwayat batuk kronis dan konsumsi obat anti-tuberkulosis 2 tablet  Fixed Dose Combination (FDC) setiap hari sudah selama 8 bulan ini serta riwayat pembengkakan pada bagian punggung bawah dan menjalani operasi di bagian belakang dekompresi dan stabilisasi posterior pada tulang belakang II-V karena kerusakan pada vertebra lumbar IV-V dan operasi kedua karena muncul benjolan setelah operasi sebelumnya. Pemeriksaan tanda vital diperoleh demam dan status gizi underweight sedangkan pemeriksaan fisik abdomen tampak region pelvis sinistra luka bernanah berukuran 4x4 cm, hiperemis di sekitarnya. Laboratorium menunjukkan leukosistosis dan anemia sedangkan hasil TCM pus dari pelvis MTB Not Detected. Pasien menerima terapi OAT kategori 1, drainase abses dan antibiotik spectrum luas imipenem. Hasil evaluasi setelah pengobatan menunjukkan adanya perbaikan klinis. Kesimpulan: Abses pelvis dapat terjadi oleh karena tuberkulosis atau non tuberkulosis. Abses pelvis yang disebabkan oleh TB seperti pada kasus ini membutuhkan terapi OAT, antibiotik dan drainase abses yang cepat sehingga prognosis baik.

Kata Kunci: tuberkulosis paru; spondylitis; abses pelvis

 




DOI: http://dx.doi.org/10.33846/sf.v15i4.5229

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