Page 107 - Abstract Book KONIKA 18

Allergy Immunology

P-AI-009
Arthritis as Main Symptom in A 2-year-old Girl with Systemic Lupus
Erythematosus: A Case Report

Immanuela Hartono , Nico Adi Saputra , Lucy Amelia 1
1,2
3
2
Hermina Podomoro Hospital , Faculty of Medicine Universitas Pelita Harapan , and Faculty of Medicine Universitas
1
3
Katolik Atma Jaya , Jakarta, Indonesia
Abstract
Background The heterogeneity of Systemic Lupus Erythematosus (SLE) symptoms has been recognized,
but not all patients develop full blown symptoms. This results in significant numbers of delay diagnosis and
even misdiagnosis. 2019 EULAR/ARC criteria can help physicians to diagnose SLE even in primary care
settings. Objective To demonstrate a mild symptom of SLE can be misdiagnosed as other causes, such as
Juvenile Idiopathic Arthritis (JIA). Case A-12 year old-girl was admitted with progressive fatigue. She had
been treated with JIA for 5 months because of her complaints of fever and pain while walking accompanied
with swelling of ankle and knee. On physical examination, she looked pale and pansystolic murmur was
found. SLE was suspected so laboratory tests were performed. Results showed anemia with positive coombs
test result, negative Rheumatoid Factor, high titer of anti-dsDNA-NcX, high titer >1:1000 of ANA test which
confirmed diagnosis of SLE (EULAR/ACR 2019 criteria). Follow up examination showed mitral regurgitation
in echocardiography, positive lupus anticoagulant test, positive IgM anti-B2-glycoprotein I antibody and
moderate titers of ACA IgG which fulfill antiphospholipid syndrome diagnosis that can be found with SLE
patients. Conclusion SLE is no longer a rare disease, however significant numbers of misdiagnosis exist,
especially when symptoms are mild such as arthritis. Complete history taking as well as examination and
laboratory data should be obtained to ensure diagnosis and prevent misdiagnosis. EULAR/ACR 2019 criteria
should be considered on patient with fever as an additional criterion that help early diagnosis, which prevent
delay of treatment as well as avoid complications.
Keywords: systematic lupus erythematosus; antiphospholipid syndrome; EULAR/ACR criteria

P-AI-010
HIV Infection in First-Born Twin: A Case Report
Ni Putu Indah Kartika Putri, I Kadek Suarca
Department of Child Health, Wangaya General Hospital, Denpasar, Bali, Indonesia
Abstract
Background Vertical transmission of HIV remains one of the biggest challenges, particularly in twin
pregnancies. Several data of twin deliveries in HIV-infected women represent transmission of HIV was more
frequent in first-born twin. Objective To report a case of HIV infection in first-born twin. Case Twins born
at 39-week gestation without any abnormality through cesarean delivery from HIV-infected mother whose
HIV status was known at time of labor. Twin-1 weighed 2700 grams and twin-2 2800 grams. HIV RNA PCR
was performed 6 weeks following zidovudine prophylactic therapy. In twin-1 virus was detected 3.66x106
copies/mL, in twin-2 no virus was detected and both were asymptomatic. Cotrimoxazole prophylactic therapy
was administered to both infants. Due to discrepancy between clinical and laboratory findings, twin-1 was
re-examined for RNA PCR and virus was detected 1.46x106 copies/mL. Other laboratory findings: leucocyte
11.61x103/µL, erythrocyte 5.00x106/µL, hemoglobin 11.7g/dl, hematocrit 34.6%, thrombocyte 295x103/µL,
AST 148 U/L, ALT 140 U/L, absolute CD4+ 980 cell/µL, percentage CD4+ 12.4%, absolute CD8+ 3,006
cell/µL, ratio CD4+:CD8+=0.33. Twin-1 was diagnosed with stage I HIV infection with severe immune
suppression and currently receive FDC ARV (zidovudine 60 mg, lamivudine 30 mg, nevirapine 50 mg) 1.5
tablet twice daily and cotrimoxazole 1x40 mg(TMP), whilst twin-2 has no clinical and laboratory signs of
HIV infection. Twin-1 is on regular medication and scheduled for viral load and CD4+ count test 6 months
following therapy. Conclusion Although asymptomatic, further evaluation and holistic management are
necessary to prevent worsening of infection in both infants.
Keywords: HIV; twins; asymptomatic; ART

KONIKA XVIII Abstract Book 59