The Jakarta Post, DEPOK | Mon, 02/23/2009 11:45 AM
A girl who was hospitalized a few days ago after receiving a diphtheria, pertussis, and tetanus (DPT) vaccine in Depok has been diagnosed as having Stephen Johnson syndrome, according to the hospital’s paediatrician.
“The syndrome occurred after the girl was treated with some medicines to cure the side effects that come naturally after an immunization, such as fever,” Dr. Indra Sugiarno said Saturday during a press conference in Depok’s Sentra Medika hospital.
The syndrome was not related directly to the immunization and giving medication for fever after a an immunization is normal, Dr. Indra said.
Head of the Depok administration’s health agency explained the chronology of the case.
The seven-year-old elementary school student had an immunization of a 0.5 cc DPT at her school on Feb. 4. The next day she felt pain in her upper arm and shoulder. On the fourth day, Feb. 7, the pain had spread to her neck as bumps began to appear on her skin.
By Monday, Feb. 9, the girl became weak and had a fever. The next day she was given two kinds of medicine for her fever at a health clinic, but her condition continued to deteriorate as the lumps spread across her upper body.
The lumps continued to appear and, after being prescribed five kinds of medicine by a doctor on Feb. 13, her condition continued to worsen; her lips turned dark blue. On Feb. 14, after being taken to another health clinic, she was referred to the hospital.
“The Depok administration will cover all expenses for the care of the child, even if the conditions were not caused directly by the immunization,” he said.
The immunization was part of a national program from the ministry of health.
“An immunization of DPT bears no absolute contraindication,” Indra said. “It means there is no specific condition that can prevent a child from being immunized.”
He said the little girl needed to be hospitalized because the syndrome could lead to infection, which can be fatal on open skin. The danger level of the disease greatly depends on how large the area of the open skin is.
Stephen Johnson syndrome is caused by hypersensitivity to medicines, viruses, or infection Dr. Indra explained. The real cause of the little girl’s case is yet to be determined by the experts studying her case, he said.
“The disease has genetical susceptibility. The case rate is one in a million people a year,” he said.
The syndrome is mostly seen in forms of defiant reactions on skin and mucus membrane.
Dr. Hapsari, the dermatologist assigned to care for the girl said, “The condition of the girl is now getting better.”
Prasetyo, the father of the girl, said his daughter can again eat soft food after only being able to take nutrition intravenously.
As of Saturday morning the lumps had disappeared, but her neck, upper arm, and chest were blackened.
Early symptoms of Stephen Johnson disease include reddening of the skin, which later turns to necrosis, causing the skin to blacken, Dr. Hapsari said.
She said the condition of the skin might return to normal in a few weeks. “It all depends on the treatment.” The color of the skin, he said, might not return to its original shade.
Dr. Indra stressed that for the interest of the patient the condition of the patient should be kept discreet, but the public’s right to be informed — as the case was related to the national program of immunization — led to the disclosure of the case, with the consent of the patient’s parents. (iwp)