Steroid Therapy on Cholestasis: A Case Report

Rendi Aji Prihaningtyas; Bagus Setyoboedi; Sjamsul Arief

doi:10.56951/mp7wkf03

Steroid Therapy on Cholestasis: A Case Report

Penulis

Rendi Aji Prihaningtyas Department of Child Health, Faculty of Medicine – Universitas Airlangga, Surabaya, East Java, Indonesia - Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
Bagus Setyoboedi Department of Child Health, Faculty of Medicine – Universitas Airlangga, Surabaya, East Java, Indonesia - Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
Sjamsul Arief Department of Child Health, Faculty of Medicine – Universitas Airlangga, Surabaya, East Java, Indonesia - Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia

DOI:

https://doi.org/10.56951/mp7wkf03

Kata Kunci:

kolestasis, neonatus, ikterus, steroid, preprandial, postprandial

Abstrak

Pendahuluan: Kolestasis adalah kondisi patologis terkait dengan proses yang dimediasi sistem imun dan menyebabkan gangguan pada aliran empedu, sehingga memerlukan diagnosis serta penatalaksanaan yang segera untuk mengoptimalkan outcome klinis. Penggunaan terapi steroid dalam pengobatan kolestasis belum pernah dilaporkan sebelumnya. Kasus: Seorang bayi laki-laki berusia 2 bulan 9 hari dengan ikterus sejak usia 1 minggu, disertai dengan tinja berwarna pucat dan urine berwarna gelap seperti teh. Pemeriksaan fisik menunjukkan adanya ikterus, hepatomegali, dan splenomegali. Pemeriksaan laboratorium menunjukkan peningkatan enzim hati (aspartate aminotransferase (AST) 292 U/l, alanine transaminase (ALT) 187 U/l, gamma-glutamyl transferase (GGT) 312,7 U/l, dan alkaline phosphatase (ALP) 882 U/l), serta peningkatan kadar bilirubin (bilirubin total 7,9 mg/dl dan bilirubin direk 6 mg/dl). Didapatkan pula IgG cytomegalovirus (CMV) reaktif. Pemeriksaan ultrasonografi abdomen dua fase menunjukkan ukuran kantong empedu preprandial sebesar 0,65 x 0,33 x 1,91 cm dan postprandial sebesar 0,37 x 0,29 x 0,73 cm. Biopsi hati menunjukkan adanya hepatitis kronis dengan fibrosis ringan (F1). Pasien diberikan pengobatan dengan methylprednisolone, yang kemudian dihentikan secara bertahap. Setelah pemberian steroid, kadar enzim hati dan bilirubin kembali normal, ukuran kantong empedu meningkat, dan warna tinja menjadi lebih gelap. Ukuran kantong empedu setelah terapi tampak mengalami peningkatan (preprandial 3,05 x 0,96 x 0,72 cm, postprandial 2,45 x 0,72 x 0,82 cm). Kesimpulan: Steroid dapat memperbaiki aliran empedu dan mencegah kerusakan organ hati lebih lanjut. Terapi yang berfokus pada sistem imun dapat menjadi pendekatan yang potensial untuk pengobatan kolestasis di masa depan.

Unduhan

Baca Selengkapnya

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