Delayed-Onset Linezolid-Induced Severe Anemia in a Young Patient With Spinal Rifampicin-Resistant Tuberculosis

Herikurniawan^1*, Aziza Harris¹

¹ Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo National Hospital.

*Correspondence Author; 085643606817; herikurniawan.md@gmail.com

ABSTRACT

Background: Linezolid is a core drug in regimens for multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) due to its potent intracellular activity against Mycobacterium tuberculosis. However, prolonged use is associated with cumulative hematologic toxicity, which can develop insidiously during extended treatment.

Case Presentation: We present the case of a 20-year-old female with spinal RR-TB who developed severe anemia after 11 months on a linezolid-containing regimen, following an initially stable hematologic profile. Laboratory monitoring revealed progressive anemia (hemoglobin 5.9 g/dL) and leukopenia (white blood cell count 1,790/mm³). Bone marrow suppression secondary to linezolid toxicity was suspected. Discontinuation of linezolid and transfusion support led to gradual hematologic recovery.

Conclusion: This case highlights the potential for delayed-onset, yet reversible, hematologic toxicity during long-term linezolid therapy, even in young patients without traditional risk factors. Sustained hematologic monitoring throughout the entire treatment course is essential to ensure patient safety and optimize outcomes in RR-TB management.

Keywords: Linezolid, Bicytopenia, Rifampicin-Resistant Tuberculosis, Hematologic Toxicity, Long-Term Monitoring, Case Report

ABSTRAK
Latar Belakang: Linezolid merupakan salah satu obat utama dalam rejimen pengobatan tuberkulosis multidrug resistant dan resisten rifampisin (MDR/RR-TB) karena aktivitas intraselulernya yang kuat terhadap Mycobacterium tuberculosis. Namun, penggunaan jangka panjang linezolid dikaitkan dengan toksisitas hematologis kumulatif yang dapat berkembang secara perlahan selama pengobatan berkepanjangan.

Presentasi Kasus: Kami melaporkan kasus seorang perempuan usia 20 tahun dengan tuberkulosis RR pada tulang belakang yang mengalami anemia berat setelah 11 bulan menjalani pengobatan dengan rejimen yang mengandung linezolid, meskipun sebelumnya profil hematologisnya stabil. Pemantauan laboratorium menunjukkan anemia progresif (hemoglobin 5,9 g/dL) dan leukopenia (jumlah leukosit 1.790/mm³). Supresi sumsum tulang akibat toksisitas linezolid dicurigai sebagai penyebabnya. Penghentian linezolid dan pemberian transfusi mendukung pemulihan hematologis secara bertahap.

Kesimpulan: Kasus ini menyoroti potensi toksisitas hematologis dengan onset tertunda namun reversibel selama terapi linezolid jangka panjang, bahkan pada pasien muda tanpa faktor risiko tradisional. Pemantauan hematologis yang berkelanjutan sepanjang durasi pengobatan sangat penting untuk menjaga keselamatan pasien dan mengoptimalkan hasil terapi pada kasus RR-TB.

Kata Kunci: linezolid, bisitopenia, tuberkulosis resisten rifampisin, toksisitas hematologis, pemantauan jangka panjang, laporan kasus

 DOI: 10.2614/ijc.v12i2

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Celline Margareth Winarto, Agus Cahyono, Olivia Benedick Sri Panggabean, Agus Suharto

Department of Medicine,University of Surabaya, Surabaya. (031) 2981353. Agus_jsc@yahoo.co.id

Latar Belakang: Asma adalah penyakit saluran napas kronik yang merupakan masalah kesehatan masyarakat yang serius di berbagai negara di seluruh dunia. Asma dapat bersifat ringan dan tidak mengganggu aktivitas, namun dapat bersifat menetap dan mengganggu aktivitas bahkan kegiatan sehari-hari. Seseorang dengan asma menetap mengalami penurunan kondisi fisik sehingga membatasi pasien untuk melakukan kegiatan sehari-hari. Menurut data WHO (World Health Organization) prevalensi asma di dunia mencapai 262 juta pada tahun 2019. Prevalensi asma di Indonesia menurut data Kemenkes RI mencapai 12 juta pada tahun 2020. Pada saat pandemi COVID-19 terjadi, pasien asma tidak melakukan kontrol rutin ke rumah sakit dikarenakan ketakutan akan terpapar COVID-19 sehingga gejala yang diderita oleh pasien menjadi semakin parah dan obat-obatan yang dikonsumsi juga habis. Namun belum banyak penelitian yang secara spesifik membandingkan tingkat perburukan asma bronkial sebelum dan saat pandemi, sehingga diperlukan studi yang mengkaji dampak pandemi terhadap kondisi pasien asma secara lebih mendalam. Penelitian ini menghadirkan kebaruan dengan membandingkan perburukan asma bronkial sebelum dan saat pandemi COVID-19, yang belum banyak diteliti sebelumnya di Indonesia.

Metode Penelitian: Penelitian dilakukan dengan mengambil data rekam medis pasien asma bronkial paru rawat jalan di RSUD Haji Provinsi Surabaya dan RSUD Ibnu Sina Gresik pada bulan Agustus-Oktober 2023 dengan total populasi 325 pasien asma bronkial dan 30 pasien asma bronkial memenuhi kriteria inklusi. Data diuji menggunakan uji komparasi Mc Nemar dengan 16 sampel yang memburuk dari hasil Mc Nemar.

Hasil Penelitian : Hasil penelitian pada uji non parametrik komparasi Mc Nemar menunjukkan nilai signifikansi 0,808 dan 23 sampel yang memburuk dari hasil uji Mc Nemar yang menunjukkan tidak didapatkan adanya perbedaan perburukan asma bronkial sebelum dan saat pandemi COVID-19.

Kesimpulan: Tidak terdapat adanya perbedaan perburukan asma bronkial sebelum dan saat pandemi COVID-19.

Kata kunci: Asma bronkial, Perburukan asma bronkial, Pandemi COVID-19.

Transkriptomik pada Tuberkulosis 

Chrispian Oktafbipian Mamudi1
1Doctoral Study Program, Faculty of Medicine, UniversitasPadjadjaran, Bandung 45363, Indonesia
2Lecturer in Internal Medicine, Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine, Krida Wacana Christian University, Jakarta, Indonesia

Abstract

Transcriptomics is the study of RNA expression that allows the identification of molecular pathways, biomarkers, and mechanisms of pathogenicity associated with infection. In the context of tuberculosis (TB), this approach provides important insights into pathogenesis, immune response, and therapeutic development. This paper reviews studies that use transcriptomics to support diagnosis, monitor treatment, and discover new therapeutic targets.
Keywords: RNA, TB, Transcriptomics

Glucocorticoid-Induced Immunosuppression and Immunocompromised Host Pneumonia

Mira Yulianti,
Department of Internal Medicine, Division of Respirology and Critical Illness, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital
Dwitya Wilasarti, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital

Abstract

Glucocorticoid is still a mainstay therapy in numerous diseases despite advances in novel chemotherapy and biologic immunomodulators. Estimated prevalence of glucocorticoid exposure is 1% in the general population. Glucocorticoid affect the immune system through various pathways, rendering those exposed to glucocorticoid immunocompromised. Studies have found that even at lower doses and short-term prescription, infection risk is increased in this population. Pneumonia is one of the leading causes of infection in the immunocompromised population, and based on the latest ATS/IDSA workshop report regarding immunocompromised-host pneumonia (ICHP), diagnosis and the etiologic workup differs compared to the community acquired pneumonia in immunocompetent patients. Approach to admission to inpatient care also differs due to the higher possibility of rapid deterioration of initially stable patients. Empirical treatment targets core respiratory pathogens but must be followed up to an attempt to determine causative pathogen according to clinical predisposition and imaging findings.
Keywords: immunocompromised host pneumonia, glucocorticoid

Obesitas dalam Kehamilan Tinjauan Literatur 

Rizkiyah Novianti1, Putri Azzahra2, Yara Anesia3, Aldina Ayunda Insani4*
1,2,3,4 Program Studi Kebidanan Program Magister, Fakultas Kedokteran
1,2,3,4 Universitas Andalas

Abstract

Obesity in pregnancy is a health problem that affects both mother and fetus, and increases the complications such as hypertension, gestational diabetes and preeclampsia. This study aims to summarize the literature related to the impact of obesity on pregnant women and fetuses and treatment methods to manage this risk. Based on a literature review of various observational, experimental, and literature studies, it was found that obesity in pregnant women correlates with a high risk of complications, including macrosomia and congenital defects in the fetus. Prevention and management efforts according to the Ministry of Health (MOH) and WHO guidelines, such as nutrition education, family support, dietary regulation, physical activity, and health programs such as GERMAS, have proven effective in reducing the risk of complications. This review is expected to provide comprehensive recommendations to improve the health of pregnant women and fetuses.
Keywords: Obesity, Pregnancy, Pregnancy Complications

Predictor Factors for 30-Day Mortality in Adult Hospitalized CAP with Immunosuppressive-Dose Glucocorticoid Use

Dwitya Wilasarti1, Mira Yulianti2, Suzy Maria3, Robert Sinto4, Adityo Susilo4, Dicky L. Tahapary5, Dono Antono6, Pringgodigdo Nugroho7
1. Department of Internal Medicine, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo General Hospital
2. Division of Respirology and Medical Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital
3. Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital
4. Division of Infectious and Tropical Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital
5. Division of Endocrinology, Metabolic, and Diabetes, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital
6. Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital
7. Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia –
Dr. Cipto Mangunkusumo General Hospital

Abstract

Background: Glucocorticoids are still frequently used for various conditions such as autoimmune diseases and malignancies, leading to immunosuppression and risk of pneumonia. Pneumonia in the immunocompromised host have a higher mortality rate compared to the immunocompetent population. The clinical manifestations of pneumonia in this population are often atypical, and clinical conditions can deteriorate rapidly compared to the time of admission, making predictors at admission necessary to assess risk mortality.
Objective: To evaluate the PSI score, lymphocyte count, increase in procalcitonin levels, history of chemotherapy, history of other immunosuppressant use, and the presence of comorbid lung disease as predictors of 30-day mortality in hospital-acquired community pneumonia patients using immunosuppressive doses of glucocorticoids.
Method: This study is a retrospective cohort study of subjects diagnosed with community-acquired pneumonia who were treated at RSUPN Dr. Cipto Mangunkusumo with a history of immunosuppressive dose glucocorticoid use. Bivariate analysis was conducted, followed by multivariate analysis of the predictor factors for 30-day mortality.
Results: Among the 267 study subjects, significant predictor factors were found, including a PSI score > 91 (RR 1.873; 95% CI 1.383 – 2.535) with a p-value < 0.001, and increased procalcitonin levels (RR 1.386; 95% CI 1.080 – 1.780) with a p-value of 0.01.
Conclusion: A PSI score > 91 and procalcitonin > 0.76 ng/dl are predictors of 30-day mortality in community-acquired pneumonia patients with a history of immunosuppressive doses of glucocorticoids treated at RSUPN Dr. Cipto Mangunkusumo.
Keywords: immunocompromised host pneumonia, glucocorticoids, 30-day mortality

Relationship between Pulse Transit Time, Oxygen Desaturation Index clan Blood Pressure with Apnoea-Hypopnea Index in Obese Patients 

Rattu R1, Kamelia T2
1Divisi Respirologi dan Penyakit Kritis RSUPN Ciptomangunkusumo/FKUI

Abstract

Background Obesity is a complex chronic disease that can impact sleep quality. In assessing sleep physiology, polysomnography is one of the methods used to record physiological parameters related to sleep, such as Apnea-Hypopnea Index (AHI), Pulse Transit Time (PTT), and Oxygen Desaturation Index (ODI). These parameters can be used to establish a diagnosis of sleep disordered breathing. Objective to know the relationship between AHI with Pulse Transit Time (PTT), Blood Presure and Oxygen Desaturation Index (ODI) in patient with obesity. Methods This study is a cross-sectional analytical study conducted at RSUPN Cipto Mangunkusumo assessing the relationship between polysomnography examination parameters, namely AHI, ODI and PTT, in obese patients (BMI ≥25 kg/m2). Results Obese patients with increasingly severe AHI were found to have significantly higher ODI (p<0.001), with a median ODI in the mild AHI group of 11.00, moderate 32.50, and severe 68.00. PTT between AHI groups were not significantly different (p=0.907). No significant relationship was found between ODI and PTT (r=-0.010, p=0.952). A positive correlation was found between systolic blood pressure and AHI score (r = 0.221, p = 0.030).
Discussion The positive correlation between AHI and ODI in this study is in accordance with the results of previous studies. ODI has the potential to be a screening parameter for sleep disordered breathing and a predictor of AHI in obese populations. PTT in previous studies was found to be ineffective in assessing sleep quality because it was influenced by age and other factors. Increased systolic blood pressure in previous studies has also been associated with increased AHI scores.
Conclusion ODI in obese patients correlates well with AHI. PTT was not found to be associated to either ODI or AHI. High systolic blood pressure is correlated with higher AHI.
Keywords: polysomnography, apnea-hypopnea index, pulse transit time, oxygen desaturation index, sleep disordered breathing, obesity

Diagnostic Prediction Model of Tuberculous Pleural Effusion 

Pradipto Utomo1, Telly Kamelia2, Ceva Wicaksono Pitoyo2, Ina Susianti Timan3, C. Martin Rumende2
1 Internal Medicine Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
2 Respirology and Critical Care Division, Internal Medicine Department, Faculty of Medicine, Universitas Indonesia,
Jakarta, Indonesia
3Clinical Pathology Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Abstract

Background: Percentage of TPE reach 20% of total EPTB cases. The diagnosis of TPE is difficult due to pleural biopsy procedure invasiveness and acid fast stain low sensitivity. Adenosine deaminase (ADA) can become reference test with high sensitivity and specificity but availability in primary health care is limited.
Objective: Analyze prediction model in diagnosis of tuberculous pleural effusion.
Methods: This study uses a cross-sectional method. The study was conducted at Cipto mangunkusumo Hospital. Independent variables consist of age, pleuritic chest pain, unilateral pleural effusion, glucose pleural fluid ≤70 mg/dL, exudative mononuclear pleural effusion, negative cytology malignancy, ultrasound characteristic and blood neutrophil-lymphocyte ratio. ADA ≥35 suggests TPE. The variaables analyzed bivariately, multivariately, ROC curve and Hosmer-Lemeshow.
Results: There were 91 subjects with characteristic of male 41 subjects (45,1%) and female 50 subjects (54,9%). Malignancy was the most frequent comorbid with 52 subjects (57,1%). Factors associated with TPE diagnosis are complex ultrasound characteristic OR 5,655 (CI 95% 1,700-18,812), pleural fluid glucose ≤70 mg/dL OR 11,262 (CI 95% 2,931-43,276) and exudative mononuclear dominant pleural effusion OR 8,567 (CI 95% 2,114-34,715). In ROC curve conclude AUC 0,841 with p<0,001 CI 95% (0,762-0,926). The result is a scoring system cut-off value ≥2 with probability 92,8%.
Conclusion: Predicted factors of TPE diagnosis are complex ultrasound characteristic, low pleural fluid glucose and exudative mononuclear dominant pleural effusion. The result is scoring system with cut-off value ≥2 with probability 92,8%.
Keywords: Tuberculous pleural effusion, ADA, complex ultrasound characteristic, exudative mononuclear dominant pleural fluid, pleural fluid glucose

COVID-19 Pulmonary Fibrosis From Acute Infection to Chronic Complications

Gede Ari Mahendra Mardaningrat1*, Putu Andrika2, Isabella Soerjanto Putri1, I Putu Hendri Aryadi1
1 Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
2 Division of Pulmonary and Critical Care, Department of Internal Medicine, Udayana University/Prof. dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali, Indonesia

Abstract

Background: SARS-CoV-2 is a virus that appeared in 2019 and led to the illness known as COVID-19. In the post-COVID-19 infection stage, a lot of patients suffer from fibrosis sequelae and alterations in pulmonary function. This systematic review and meta-analysis aimed to establish the frequency of pulmonary fibrosis after COVID-19 infection, identify risk factors, and recognize biomarkers linked to pulmonary fibrosis development post-COVID-19 infection.
Methods: Following PRISMA and MOOSE guidelines, studies published between January 1, 2020, and June 31, 2024, were analyzed.
Results: Fifteen studies (2,240 patients) revealed a 42.7% prevalence of post-COVID-19 pulmonary fibrosis. Patients with fibrosis were older (mean age 60 years vs. 49.5 years). Heart disease was a significant comorbidity. Symptoms included shortness of breath, chest pain, and muscle pain (p<0.05). Severe COVID-19 (ICU admission, mechanical ventilation, steroid/immunoglobulin therapy) increased fibrosis risk (p<0.05). Radiological findings included consolidation, ground-glass opacity, parenchymal bands, and interlobular thickening. Elevated IL-6, TNF-α, LDH, CRP, and D-dimer levels correlated with fibrosis (p<0.05).
Conclusion: Post-COVID-19 pulmonary fibrosis affected 42.7% of patients, strongly linked to severe COVID-19 and associated treatments. Common lung abnormalities included consolidation and parenchymal bands. Biomarkers IL-6, TNF-α, LDH, CRP, and D-dimer were significant contributors to fibrosis development.
Keywords: Acute infection, Chronic complications, COVID-19, Pulmonary fibrosis, SARS-CoV-2

Jasmine Asy Syauqi Ramadhani¹, Yasmin Nurfitriyanti², Maedia Salsabilla³, Naurah Bagia Aryani⁴, Rifqi Muhammad Hajid⁵
Prodi Farmasi Fakultas Kedokteran Universitas Negeri Semarang Semarang, Jawa Tengah

Abstract

Secondary metabolites are compounds that are the result of biosynthesis derived from primary metabolites, and are generally produced by organisms to protect themselves from the environment and from attacks by other organisms. Vis spectrophotometry (vis spectrophotometry) is an analytical technique used to measure the absorbance of light by a sample at a certain wavelength in the visible light range (vis). This study aims to analyze various secondary metabolites in natural materials using Vis spectrophotometry. Secondary metabolites such as flavonoids, terpenoids, and alkaloids have an important role in plant defense and provide various health benefits for humans. Vis spectrophotometry is used to identify and measure the concentration of these metabolites based on their absorbance characteristics at certain wavelengths. The results of the study showed that the Vis spectrophotometry method is able to provide accurate identification and efficient quantification of secondary metabolites in various natural material samples. Flavonoids, terpenoids, and alkaloids were successfully identified and quantified using this technique. This study also confirms that Vis spectrophotometry is a very useful tool in chemical analysis and has wide applications in the pharmaceutical, nutritional, and cosmetic industries. Overall, this study provides a deep insight into the use of Vis spectrophotometry in secondary metabolite analysis and shows the potential of this method for further research and practical applications in various fields.
Keywords: Secondary Metabolites, Natural Products, Vis Spectrophotometry