TEACHING BANGSAL

POST HERPETIC
NEURALGIA

GROUPMEMBERS
1.
2.
3.
4.
5.
6.
7.
8.

HarrisonRandyBungasalu
(C11111110)
MuhammadIchsanPrasetya
(C11111304)
AhmadAuliaRizaly
(C11111154)
Muh.FaudhyAriyandi
(C11111896)
AnggaPrasetya
(C11111905)
Radina
(C11111901)
IzzatulMuhhzakirah
(C11111801)
RibkaMelisaElisabethA.
(C11111804)

PATIENTSIDENTITY

Name :Mr.UT
Gender :Male
Age :52y.o
MedicalRecord :723030
MarritalStatus :Married
Religion :Moslem
Address:Pinrang
Occupation :XXX
AdmissionDate :21August2015

HISTORYTAKING
Anamnesis:Heteroanamnesis
MainComplaint:Redrashwithpainontheleftwaist
DetailsofAnamnesis:
Patient, A man 52 y.o consulled from neurology department
withredrashwithpainatleftwaist.Experiencesince3weeks
ago.Atfirst,rashappearedontheleftwaist,andthenspread
to the left inguinal region, and the to left abdominal region.
Thecomplaintcomewithitchy.Nofever.Before,patienthave
experiencedwithherpeszosterdiseasesince6weeksago.

HISTORYTAKING
Medical History: He has experienced with herpes zoster
diseasesince6weeksago.
TreatmentHistory:CreamPotion
FamilyHistorywithSameComplaint:()
AllergyHistory:()

CURRENTSTATUS

Conciousness :Composmentis(GCS15)
GeneralCondition :Moderate
Hygiene :Moderate
Nutrition :Normal
VitalSign
BloodPressure :100/70mmHg
HeartRate :80x/minutes
RespiratoryRate :20x/minutes
Temprature :36,8C

Physicalexamination

Anemic(),Icterus(),Cyanosis()
Cor/Pulmonal:Normal
Abdomen:Normal,Peristaltic(+)Normal
Extremities:Edema()
LymphNodes:Enlargement()

DERMATOVENEREOLOGISTATUS
Region : Truncus anterior et posterior sinister
thoracal1011dermatomes
Size:Variation,Biggestsize5,5cmx3cm
Effloresence : Macula Hypopigmentation, Macula
Erhytema,Crusta

C.
A.

REGIOTRUNCUS
ANTERIOR:
A. MACULA
ERYTHEMA

B.

B. MACULA
HYPOPIGMEN
TATION
C. CRUSTA

B.

A.

REGIOTRUNCUS
POSTERIOR:
A. MACULA
ERYTHEMA
C.

B. MACULA
HYPOPIGMEN
TATION
C. CRUSTA

LABORATORYRESULT
BLOODTEST

WBC

RBC

:4.84(106/uL)

HB

:13.6(g/dL)

HCT

:41.5(%)

PLT

:476(103/uL)

RESULT

:23.7(103/uL)

:Leucocytosis,Thrombocytosis

KIDNEYFUNCTION

Ureum

Creatine

:30mg/dl
:0.7mg/dl

LIVERFUNCTION

Albumin

:3.3

IMMUNOSEROLOGY

HbsAg

AntiHCV

:NonReactive
:NonReactive

RESUME
Patient, A man 52 y.o consulled from neurology department
withredrashwithpainatleftwaist.Experiencesince3weeks
ago.Atfirst,rashappearedontheleftwaist,andthenspread
to the left inguinal region, and the to left abdominal region.
Thecomplaintcomewithitchy.Nofever.Before,patienthave
experiencedwithherpeszosterdiseasesince6weeksago.
The general condition are moderate, conciusness, normal nutrition.
The vital sign is normal. Blood pressure 100/70mmHg, Repiration
rate20x/minutes,Heartrate80x/minutes,Temprature36,8C.

RESUME
Fromthedermatologystatusfoundthatthelesionon
truncus anterior and posterior region of left waist,
withvarioussize.Thebiggestsizeis5.5cmx3cm
Efluorescence found : Macula Hypopigmentation,
MaculaErhytema,andCrustaontruncusanteriorand
posteriorregionofleftwaist.

DifferentialDiagnosis
Cardiacdisease
Bellparalysis
Trigeminalneuralgia

14

DIAGNOSIS

POST
HERPETIC
NEURALGIA

Treatment

R/NatriumDiclofenaktablet/12H/Oral
R/MefenamicAcid500mg/8H/Oral
R/Cetirizin10mg/24H/Oral(001)
R/Betametasonecream+Gentamicincream
(everymorningandevening)

16

Resume
Patienthadbeensufferingfromhemiplegiasincethreeweeksbefore
beingadministeredinthehospital.Thehistoryoffeverandtrauma
weredenied.Headachehadbeenpresentsinceoneyearago,andfelt
thatitwasworsening
VitalSign
BloodPressure :100/70mmHg
HeartRate :80x/minute
RespiratoryRate :20x/minute
Temprature :36,8C
Dermatological:
Location : Anteroposterior sinistra of the trunk
Efflorescence : Hypopigmented macule, eritematous macule, erosion, crust.
17

Diagnosis:PostHerpeticNeuralgia
DD:
Cardiacdisease
Bellparalysis
Trigeminalneuralgia

18

Management
Analgesic
Tramadol,400mg/day,dividedinto4doses
Oxycodone60mg/day
Antiepilepsy
Gabapentin
Karbamazepin
Iamogotrin
Antidepressant
Amitriptilin
Topicaltherapy
Capsaicin
19

DermatologicStatus
Region : Truncus anterior et posterior sinister
thoracal1011dermatomes
Size:Variation,Biggestsize5,5cmx3cm
Effloresence : Macula Hypopigmentation,
MaculaErhytema,Crusta

20

Discussion
PostHerpeticNeuralgiaisdefinedvariously:
Painthatoccursafterthehealingofskinlesion
Every pain that occurs after 1, 3, 4, or 6
monthsaftertheappearanceofskinlesion
Pain that occurs on 90120 days after the
appearanceofskinlesion

21

Etiology
PostHerpetic Neuralgia occurs if the nerve
fibre are damaged during an outbreak of
shingles. Damaged fibers arent able to send
messages from your skin to brain as they
normally do. Instead, the messages become
confused and exaggerated, causing chronic,
often excruciating pain that may persist for
monthorevenyears.
22

Epidemiology
In USA, PostHerpetic Neuralgia is the third
most common cause after low back pain and
diabeticneuropathy
PostHerpetic Neuralgia develops on 73% of
patients above age 70 y.o, 47% of patients
above 60 y.o, and only 27% of patient above
55y.o

Patofisiologi
Virusreplicatesin
dorsalganglion

Inflammationon
neuroncell

Virusspreads
centrifugallyfromto
nervetotheskin

PeripheralNerve:
1.Heathyperalgesia
2.Allodinia

Sensitisation/deaffere
ntationofperipheral
andcentralnerve
element

Inflammationand
Damagetoperipheral
nerve

CentralNerve:
1.Allodinia&
hyperalgesia

Signs&Symptoms
Spontaneouspain,describbedasaching,throbbing
andburnlikepain)
Intermitentpain
Painthatisstimulatedbystimulationthatnormally
doesntinducepain
Beberapa pasien mengeluh gatal yang intens /
Somepatientscomplaintohaveintensitch
HiperalgesiaHyperalgesia
Paroxysmal
25

Diagnosis
DiagnosticExamination
NeurologicexaminationofTrigeminal
nerveandotherneurologicexamination
SmearofvesicleandPCRfor
confirmationofinfection
Viralcultureorimmunofluroscence
stainingtodifferentiateHerpesSimplex
fromHerpesZoster
26

Treatment
Analgesik
Tramadol,400mg/haridibagidalam4dosis
Oxycodone60mg/hari
Antiepilepsi
Gabapentin
Karbamazepin
Iamogotrin
Antidepresan
Amitriptilin
Terapitopikal
Capsaicin

Prognosis
Advitam:Bonam
Adfunctionam:Bonam
Adsanactionam:Bonam

28

REFERENCE
1. Donald Y.M. Leung, Lawrence F. Eichenfield, & Mark Boguniewicz. Atopic Dermatitis
(atopicEczema).Dalam:Fitzpatricksdermatologyingeneralmedicin8 th edvolume1.Mc
GrawHill.2012.
2. JamesWD,BergerTG,ElstonDM. AndrewsDiseaseoftheSkin:ClinicalDermatology.
11thed.USA:SaundersElsevier;2011
3. Burns T, Breathnach S, Cox N, Griffiths C. Rook's Textbook of Dermatology: Wiley
Blackwell;2010
4. Regina, Wijaya L. Neuralgia Pascaherpetika. Jakarta : Departemen SMF Ilmu Kulit dan
KelaminFakultasKedokteranRSAtmaJaya,2012
5. SumaryoS.PreventionandTreatmentofPostherpeticNeuralgiatobeTravelling.Semarang
:BagianSMFIlmuKulitdanKelaminFakultasKedokteranRSUPDr.Kariadi,2011
6. PortellaAVT,deSouzaLCB,GomezJMA.HerpesZosterandPostherpeticNeuralgia.Sao
Paolo:2013
7. Reliala L. Neuralgia Pascaherpes: Nyeri Neuropatik Patofisiologi dan Penatalaksanaan.
KelompokStudiNyeriPerdossi:2001
8. PatelB.EndodonticDiagnosis,Pathology,andTreatmentPlanning.2015
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Thank You

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