VARICELLA ZOSTER

Supervisor: Prof. Dr. Indropo Agusni, dr., SpKK(K)

By: Fahmy Indra Adhyanti M. F. Alhaqqi S. S. Resi Prastikarunia 010710273 010810042 010810489 010810494

FACULTY OF MEDICINE AIRLANGGA UNIVERSITY DERMATOLOGY DEPARTMEN DR. SOETOMO HOSPITAL SURABAYA 2013

IDENTITY Name Sex Age Address Occupation Tribes Religion Registry number Admission date Examination date : Akma : Male : 5 yo : Sawahan Baru 1 / 36-38 : Kindergarten student : Javanese : Islam : 10.78.66.69 : 21st January 2013 : 25th January 2013

BASIC DATA 1. ANAMNESIS 1.1 Chief Complaint Appearance of blisters all over the body 1.2 Records of Recent Illness His mother took the patient to the hospital with the appearance of the blister scattered all over his body since 3 days before admission. At first, the blister showed up as the small red dots on the neck, which then gradually become a vesicle, and then spread to the face, body, hands, and legs. The mother said that the children were keen on scratching his body since the appearance of the blister, however she didnt indicates that the blisters were found to be painful.
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One day before the blister, the mother said that the patient got a fever along with cough. The cough disappeared along with the appearance of the blister, however the fever remained until a few days after the admission. The patient didnt suffer from nausea and vomiting. There is also no abnormality in the stool and urine. 1.3 Records of Past Illness The patient has never gotten the same illness. The patient also got a history of TOF since birth, however it had been operated in 2009. The patient had febril seizures 2 times before. The patient has no record either on asthma or allergy to medicine and food. 1.4 Records of Family Illness The mother admitted that she got the same disease 2 weeks before her child. In the family there is no history of hypertension and Diabetes mellitus. There is also no record on asthma and food or medicine allergy 1.5 Psychosocial Patient is an only child. He is now a student of kindergarten

2. PHYSICAL EXAMINATION 2.1 Status Generalis

GCS BP HR RR T : 456, compos mentis : 110/70 mmHg : 88 x/menit : 20 x/menit : 37,1oC

Weight : 13 kg

i. Head and Neck General Eyes Nose Mouth Neck : Conjunctiva Sclera : anemia (-) : jaundice (-) : There is no increase of JVP

Pupil round isochors 3mm/3mm Visus within normal range Eyebrow normal : Abnormality (-) : Abnormality (-) : Abnormality (-)

ii. Thorax Pulmo Inspection Shape symmetrical Movement symmetrical Retraction (-)

Palpation Movement symmetrical Tactile fremitus normal

Percussion Percussion sound sonor Pain (-)

Auscultation Breathing sound vesicular Ronchi (-) Wheezing (-)

Cardio Ictus, palpable on ICS V mid clavicular line sinistra Heart pulsation, palpable on the apex Palpable additional sound (-) Thrill (-) 4

S1 S2 single, regular Murmur (-) Gallop (-)

iii. Abdomen - Shape: flat - Bowel sound (+) Normal - Hepar dan Lien impalpable - Timpani iv. Inguinal Genitalia Anus Within the normal range

v. Extremities Upper Extremities o CRT <2 o Deformities: -/o Edema: -/ Lower Extremities o CRT <2 o Deformities: -/o Edema: -/-

2.2 Status Dermatologic Region : Generalisata

Efflorescence: clear fluid-filled vesicles over erythematous macular, scattered, pustule -, papule -, erosion +, crusts +

3. LABORATORY FINDINGS (22 January 2013) Complete Blood Count WBC RBC 7,14 x 103 5,15 x 106
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PLT Hb LED

157 x 103 13,7 20

Urine Test pH Leu Nit Pro Glu Ket Bil Ery Leu Epi Cast 5 Normal 0-1 0-1 -

PROBLEM LIST Appearance of the blister scattered all over his body since 3 days before admission One day before the blister, the patient got a fever along with cough The mother admitted that she got the same disease 2 weeks before her child

SUMMARY His mother took the patient to the hospital with the appearance of the blister scattered all over his body since 3 days before admission. At first, the blister showed up as the small red dots on the neck, which then gradually become a vesicle, and then spread to the face, body, hands, and legs. The
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blister were itchy yet not painful. One day before the appearance of the blister, the patient got a fever and a cough. Patients mother admitted that she got the same disease 2 weeks before her child. In regio generalisata were found clear fluid-filled vesicles over erythematous macular, scattered, pustule -, papule -, erosion +, crusts +. There is no abnormality found in laboratory examination

DIAGNOSIS Varicella Zoster

DIFFERENTIAL DIAGNOSIS 1. Variola / Small pox 2. Viral Exanthema 3. Herpes Zoster 4. Impetigo Contagiosa

PLANNING I. Diagnosis 1. X-Ray Thorax 2. Culture virus 3. Tzank test

II.

Therapy 1. Paracetamol 3 x 130 mg/ day 2. Acyclovir 4 x 260 mg/ day 3. Na Fusidat

III.

Monitoring 1. Vital sign 2. Patients complain 3. Lesion protection

IV.

Education
1. Avoid scratching or rubbing the itchy areas. Keep fingernails short to avoid damaging the skin from scratching. 2. Wear cool, light, loose bedclothes. Avoid wearing rough clothing, particularly wool, over an itchy area. 3. Take lukewarm baths using little soap and rinse thoroughly. Try a skinsoothing oatmeal or cornstarch bath. 4. Apply a soothing moisturizer after bathing to soften and cool the skin.
5.

Avoid prolonged exposure to excessive heat and humidity.