Evolução Atípica de Angina de Plaut-Vincent em Criança: Relato de Caso/Atypical Evolution of Plaut-Vincent’s Angina in Child: A Case Report
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Abstract
Introdução: A angina de Plaut-Vincent é uma afecção úlcero-necrótica causada pela simbiose de um bacilo fusiforme (Fusobacterium necrophorum) e um espirilo (Borrelia vincenti). Ambos são agentes saprófitas habituais da cavidade oral, porém, quando associados, determinam o caráter patogênico da doença. Casuística: Trata-se do caso de uma paciente do sexo feminino, 4 anos de idade, que deu entrada no pronto socorro com choque séptico descompensado não responsivo a volume com necessidade de drogas vasoativas (DVA), além de má conservação dentária, e amigdalas necrosadas. Em 48h evoluiu com piora hemodinâmica refratária a DVA e introdução de hidrocortisona, com crises convulsivas e hemiplegia à esquerda. Foi solicitada TC crânio a qual evidenciou AVC isquêmico. Discussão: Ocorre geralmente em condições de desnutrição e má higiene oral, tendo sua maior incidência entre os adultos-jovens e adolescentes. Cursa com necrose das amigdalas, halitose intensa e disfagia. Conclusão: Considerando que a Angina de Plaut-Vincent acomete principalmente adultos jovens, torna-se de grande relevância relatar o caso de uma paciente pediátrica, que evoluiu de forma incomum, apresentando lesões isquêmicas cerebrovasculares.
Palavras-chave: amigdalite, isquemia cerebral, choque séptico, angina.
ABSTRACT
Introduction: Plaut–Vincent’s angina is an ulcer-necrotic disease caused by the symbiosis of a fusiform bacillus (Fusobacterium necrophorum) and spirillum (Borrelia vincenti). Both are common saprophytic agents of the oral cavity, but when combined determine the pathogenic of the disease. Case report: We describe the case of a female patient, 4 years old, which gave entered the emergency room with decompensated septic shock unresponsive to volume in the need of vasoactive drugs (DVA), moreover poor dental conservation and necrotic tonsils. After 48h evolved with hemodynamic deterioration refractory to VAD and insertion of hydrocortisone, with convulsion and left hemiplegia. A cranial CT was requested and revealed ischemic stroke. Discussion: Usually occurs in conditions of malnutrition and poor oral hygiene and has a high incidence among the young adults and adolescents. Courses with necrosis of the tonsils, severe halitosis and dysphagia. Conclusion: Whereas the Plaut-Vincent Angina affects mainly young adults, it is extremely important to report the case of a pediatric patient that led in an unusual way, with cerebrovascular ischemic lesions.
Keywords: tonsillitis, cerebral ischemia, septic shock, angina.
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