Anti-DFS70 sebagai Penanda Kejadian Autoimun Nonsistemik (Primary Billiar Cholangitis) pada Systemic Lupus Erythematosus

Yasjudan Rastrama Putra, Deshinta Putri Mulya, Fahmi Indrarti

Abstract

Anti-dense fine speckled 70 (DFS70) dikenal sebagai penanda autoimun nonsistemik. Hanya 1% pasien gangguan autoimun sistemik ditemukan anti-DFS70 dan 2–22% positif pada populasi sehat. Dari penelusuran kami belum pernah dilaporkan anti-DFS70 positif pada pasien systemic lupus erythematosus (SLE) dengan komorbid primary billiary cholangitis (PBC). Artikel ini menyajikan sebuah kasus pada seorang wanita 40 tahun dengan SLE sejak satu bulan, datang dengan keluhan lemas, nafsu makan berkurang, ikterik, atralgia, rambut rontok, dan demam tanpa sebab yang jelas sejak tujuh hari sebelumnya. Total bilirubin 9,46 mg/dl, direk bilirubin 7,73 mg/dl, gamma-glutamyl transferase (GGT)  503 U/L, alkali fosfatase (ALP) 520 U/L, ANA-IF 1:1000, ANA-profile borderline pada anti-centromer B, dan positif tiga pada DFS70. Gambaran magnetic resonance cholangiopancreatography (MRCP) mendukung primary billiar cholangitis (PBC). Setelah dua bulan mendapat terapi ursodeoxycholic acid (UDCA) 2 x 250 mg, ALP dan GGT kembali dalam batas normal. Hal ini mengingatkan klinisi bahwa penemuan anti-DFS70 pada SLE memerlukan evaluasi mendalam apakah juga terdapat kejadian autoimun nonsistemik. Primary billiar cholangitis (PBC) yang muncul bersama dengan SLE bisa membaik dengan terapi UDCA standar.

Kata Kunci: ANA, DFS70,  primary biliary cholangitis, systemic lupus erythematosus


Anti-DFS70 as Nonsystemic Autoimmune (Primary Billiar Cholangitis) Concomitant Disease Marker in Systemic Lupus Erythematosus

Anti-dense fine speckled 70 (DFS70) is known as a non-systemic autoimmune marker. It is only found in 1% of systemic autoimmune patients and 2–22% in healthy population. To the best of our knowledge, no anti-DFS70 positive has been reported in systemic lupus erythematosus (SLE) patients with primary billiary cholangitis (PBC) comorbidities. We reported a 40-year-old woman that was diagnosed with SLE 1-month before, came to the hospital due to seven days of fatigue, loss of appetite, icteric, arthralgia, hair loss, and unexplained fever. Total bilirubin was 9.46 mg/dl, direct bilirubin 7.73 mg/dl, gamma-glutamyl transferase (GGT)  503 U/L, alkaline phosphatase (ALP) 520 U/L, ANA-IF 1:1000, ANA-profile measurement borderline on the anti-centromere B, and three positives on the DFS70. Magnetic resonance cholangiopancreatography (MRCP) shown the PBC feature. After ursodeoxycholic acid (UDCA) therapy 250 mg twice daily, ALP and GGT backed to normal limits within two months. This case reminds the doctor that anti-DFS70 finding in SLE needs further evaluation, whether other nonsystemic autoimmune exist or not. Concomitant PBC with SLE well responded with UDCA standard therapy.


Keywords

ANA, DFS70, primary biliary cholangitis, systemic lupus erythematos

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