Kor Pulmonal pada Tuberkulosis Paru: Sebuah Laporan Kasus

Bonfilio Neltio Ariobimo; Nurun Nujum

doi:10.36452/jkdoktmeditek.v29i3.2760

Authors

Bonfilio Neltio Ariobimo Rumah Sakit Umum Daerah Ibnu Sina, Kabupaten Gresik, Jawa Timur, Indonesia
Nurun Nujum Rumah Sakit Umum Daerah Ibnu Sina, Kabupaten Gresik, Jawa Timur, Indonesia

DOI:

https://doi.org/10.36452/jkdoktmeditek.v29i3.2760

Keywords:

Hipertensi pulmonal, kor pulmonal, tuberkulosis paru

Abstract

Tuberkulosis paru merupakan salah satu masalah kesehatan global. Beberapa penelitian sebelumnya melaporkan bahwa ditemukan adanya kemungkinan hubungan antara penyakit TB dan Hipertensi Pulmonal. Hipertensi Pulmonal dapat mengalami perkembangan lebih lanjut yang disebut sebagai kor pulmonal. Kami melaporkan pasien wanita 22 tahun datang ke instalasi gawat darurat dengan keluhan utama sesak nafas sejak 2 hari dirasakan semakin memberat terutama saat berjalan. Pasien juga mengeluhkan bengkak di kedua kakinya sejak 1 minggu ini. Pasien memiliki riwayat TB paru 8 bulan yang lalu namun hanya menjalani pengobatan selama 4 bulan. Pemeriksaan sinar-x thorak menunjukkan gambaran fibroinfiltrat disertai multipel kavitas di daerah parahilar dan infrahilar paru kanan dan kiri, selain itu juga ditemukan kardiomegali. Ekokardiografi menunjukan regurgitasi trikuspid ringan, dilatasi atrium kanan, dilatasi ventrikel kanan, Tricuspid Annular Plane Systolic Excursion menurun, dan efusi perikardial minimal. Diagnosis klinis mendukung gambaran suatu kor pulmonal akibat TB paru. Kondisi vasokonstriksi, inflamasi kronis, dan hipoksia alveolar kronis ini yang menyebabkan perubahan pembuluh darah paru disertai destruksi pembuluh darah paru yang bersifat ireversibel. Hal ini pada akhirnya dapat menyebabkan disfungsi ventrikel kanan. Penatalaksanaan tuberkulosis paru dapat mencegah perkembangan HP yang berujung kor pulmonal. Deteksi dini sangat penting pada pasien berisiko terkena hipertensi pulmonal.

References

Marjani M, Baghaei P, Malekmohammad M, Tabarsi P, Sharif-Kashani B, Behzadnia N, et al. Effect of pulmonary hypertension on outcome of pulmonary tuberculosis. Brazilian J Infect Dis [Internet]. 2014;18(5):487–90. Available from: http://dx.doi.org/10.1016/j.bjid.2014.02.006

Ahmed AEH, Ibrahim AS, Elshafie SM. Pulmonary hypertension in patients with treated pulmonary tuberculosis: Analysis of 14 consecutive cases. Clin Med Insights Circ Respir Pulm Med. 2011;5(1):1–5.

Wen-ting L, Chang-wei W, De-jian B, Wei S. Arterial partial pressure of oxygen and procalcitonin levels correlate with pulmonary artery systolic pressure in patients with active pulmonary tuberculosis. Int J Infect Dis [Internet]. 2022;117:87–92. Available from: https://doi.org/10.1016/j.ijid.2022.01.060

Jordan TS, Spencer EM, Davies P. Tuberculosis, bronchiectasis and chronic airflow obstruction. Respirology. 2010;15(4):623–8.

Chen Y, Liu C, Lu W, Li M, Hadadi C, Wang EW, et al. Clinical characteristics and risk factors of pulmonary hypertension associated with chronic respiratory diseases: A retrospective study. J Thorac Dis. 2016;8(3):350–8.

Bhattacharyya P, Saha D, Bhattacherjee PD, Das SK, Bhattacharyya PP, Dey R. Tuberculosis associated pulmonary hypertension: The revelation of a clinical observation. Lung India. 2016;33(2):135–9.

Thienemann F, Dzudie A, Mocumbi AO, Blauwet L, Sani MU, Karaye KM, et al. The causes, treatment, and outcome of pulmonary hypertension in Africa: Insights from the Pan African Pulmonary Hypertension Cohort (PAPUCO) Registry. Int J Cardiol [Internet]. 2016;221:205–11. Available from: http://dx.doi.org/10.1016/j.ijcard.2016.06.242

Verma AK. Tuberculosis and pulmonary hypertension: Commentary. Lung India. 2016;33(2):232–3.

Amaral AFS, Coton S, Kato B, Tan WC, Studnicka M, Janson C, et al. Tuberculosis associates with both airflow obstruction and low lung function: BOLD results. Eur Respir J. 2015;46(4):1104–12.

Harries AD, Ade S, Burney P, Hoa NB, Schluger NW, Castro JL. Successfully treated but not fit for purpose: Paying attention to chronic lung impairment after TB treatment. Int J Tuberc Lung Dis. 2016;20(8):1010–3.

Kalla IS, Bch MB, Sa CP, Critical C, Sa C, Miri A, et al. Kalla IS, Miri A, Seedat F. Occult pulmonary arterial hypertension in patients with previous pulmonary tuberculosis. Afr J Thorac Crit Care Med. 2020 Dec 1;26(4):10.7196/AJTCCM.2020.v26i4.110. doi: 10.7196/AJTCCM.2020.v26i4.110. PMID: 34240037; PMCID: PMC. 2020;26(4):133–7.

Nowroozpoor A, Hshemian SM, Malekmohammad M, Marjani M, Tabarsi P, Jamaati H, et al. Usefulness of pulmonary artery diameter in diagnosing pulmonary hypertension in patients admitted to tuberculosis intensive care unit. Int J Mycobacteriology [Internet]. 2016;5:S56. Available from: http://dx.doi.org/10.1016/j.ijmyco.2016.10.032

Bahmid AR, Hasan H. Seorang Wanita dengan Cor Pulmonale Terkait Silikosis. J Respirasi. 2020;5(3):72.

Malipatil A, Dhulappanavar C, Chaudhary H, . H. Etiology and clinical profile in chronic cor pulmonale. Int J Adv Med. 2019;7(1):168.

Mandoli GE, Sciaccaluga C, Bandera F, Cameli P, Esposito R, Andrea AD, et al. Cor pulmonale: the role of traditional and advanced echocardiography. Heart Fail Rev. 2020;

Ascha M, Renapurkar RD, Tonelli AR. A review of imaging modalities in pulmonary hypertension. Ann Thorac Med. 2017;12(2):61–73.

Weitzenblum E. General cardiology Chronic Cor Pulmonale. Heart [Internet]. 2013;89(2):225–30. Available from: https://dx.doi.org/10.1136%2Fheart.89.2.225

Rubin LJ. Cor pulmonale revisited. J Am Coll Cardiol. 2013;62(12):1112–3.

Task A, Members F, Humbert M, Germany MMH, Berger RMF, Denmark JC, et al. 2022 ESC / ERS Guidelines for the diagnosis and treatment of pulmonary hypertension Developed by the task force for the diagnosis and treatment of ( ESC ) and the European Respiratory Society ( ERS ). Endorsed by the International Society for Heart and Lu. Eur Heart J. 2022;1–114.

Broaddus VC, Ernst JD, Jr TEK, Lazarus SC, Sarmiento KF, Schnapp LM, et al. Murray & Nadel’s Textbook of Respiratory Medicine. 7th ed. Philadelphia: Elsevier Ltd; 2021.

Jo YS, Park JH, Lee JK, Heo EY, Chung HS, Kim DK. Risk factors for pulmonary arterial hypertension in patients with tuberculosis-destroyed lungs and their clinical characteristics compared with patients with chronic obstructive pulmonary disease. Int J COPD. 2017;12:2433–43.

Sharda N. Cor Pulmonale as a Rare Presentation of Pulmonary Tuberculosis in a Child. Pediatr Infect Dis J. 2013;32(4).

Golubinskaya EP, Filonenko TG, Kramar T V., Yermola YA, Kubyshkin A V., Gerashenko A V., et al. Dysregulation of VEGF-dependent angiogenesis in cavernous lung tuberculosis. Pathophysiology [Internet]. 2019;26(3–4):381–7. Available from: https://doi.org/10.1016/j.pathophys.2019.11.004

Alajaji W, Baydoun A, Al-Kindi SG, Henry L, Hanna MA, Oliveira GH. Digoxin therapy for cor pulmonale: A systematic review. Int J Cardiol [Internet]. 2016;223:320–4. Available from: http://dx.doi.org/10.1016/j.ijcard.2016.08.018

Forfia PR, Trow TK. Diagnosis of pulmonary arterial hypertension. Clin Chest Med [Internet]. 2013;34(4):665–81. Available from: http://dx.doi.org/10.1016/j.ccm.2013.09.001