embolia séptica pulmonar â a propósito de um caso clÃnico
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ID: 238399
2008
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Abstract
Resumo: A embolia séptica pulmonar (ESP) é frequentemente a apresentação clÃnica de variadas doenças de etiologia infecciosa, por vezes subdiagnosticadas na prática clÃnica. Esta entidade foi descrita há cerca de 30 anos, quase sempre associada a toxicodependentes com endocardite infecciosa da válvula tricúspide. Ao longo das últimas três décadas, a epidemiologia desta sÃndroma sofreu alterações relevantes. No entanto, carece a existência na literatura de critérios de diagnóstico de ESP validados. Os autores apresentam um caso clÃnico de endocardite infecciosa da válvula tricúspide em toxicodependente, cuja forma de apresentação foi a ESP. O doente apresentava sintomas constitucionaise febre com um mês de evolução. A radiografia de tórax (RXT) apresentava múltiplos infiltrados alveolares no terço inferior do campo pulmonar direito. O diagnóstico inicial foi pneumonia da comunidade, persistente. O ecocardiograma transtorácico revelou a presença de uma vegetação na válvula tricúspide. Foi isolada em hemoculturas espécie de Staphylococcus aureus meticilino-sensÃvel. O doente realizou antibioterapia dirigida com sucesso terapêutico.Perante estes achados clÃnicos e após revisão da literatura, os autores propõem critérios de diagnóstico de ESP.Rev Port Pneumol 2008; XIV (6): 881-885 Abstract: SPE is a rare syndrome, although a frequent clinical presentation of several disorders, many times misdiagnosed in medical practice. It was described 30 years ago, almost always associated with intravenous drug abuse. Recent reports indicate that the epidemiology of patients with septic pulmonary embolism has changed over the past 30 years. We report a case of septic pulmonary embolism associated with tricuspid valve endocarditis. The patient had a personal history of intravenous drug abuse. The chief complaints were fever, anorexia and weight loss for 30 days. A chest radiograph revealed multiple pulmonary infiltrates in the lower third of the right lung. Antimicrobial agents were instituted in order to treat pneumonia, with no success. Blood cultures were positive for methicilin-susceptible Staphylococcus aureus. Transthoracic ecocardiography revealed a vegetation in the tricuspid valve. Oriented antimicrobial therapy was introduced, successfully. We have reviewed the literature, suggesting thereafter diagnostic criteria for septic pulmonary embolism.Rev Port Pneumol 2008; XIV (6): 881-885 Palavras-chave: Embolia séptica pulmonar, endocardite infecciosa, infiltrados pulmonares, Key-words: Septic pulmonary embolism, infectious endocarditis, pulmonary infiltrates
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| Authors | ;LuÃs Coentrão;Jorge Oliveira |
| Journal | the journal of applied psychology |
| Year | 2008 |
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