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Manifestações hepatoesplénicas da infecção por bartonella henselae : a propósito de um caso clínico
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A espécie Bartonella henselae (BH) encontra-se descrita na literatura há cerca de quarenta anos. Inicialmente conhecida como o agente causador da doença da arranhadela do gato, é hoje, devido essencialmente ao desenvolvimento dos métodos complementares de diagnóstico, responsável por inúmeras manifestações sistémicas com afeção orgânica. A sua incidência clínica, apesar de baixa, mostra uma tendência crescente. Das manifestações sistémicas com envolvimento de órgão mais frequentes, destaca-se a doença hepatoesplénica, caracterizada pela existência de microabcessos hepáticos e/ou esplénicos, que se traduzem ao exame histológico por granulomas com centro necrótico. O seu tratamento é ainda controverso, dado o seu curso geralmente benigno. O presente trabalho reflete o caso de uma criança de 3 anos que se apresenta com um quadro de febre prolongada associada a adenomegalias cervicais bilaterais e hepatoesplenomegalia. Não se verificou melhoria após antibioterapia diversa, sendo posteriormente referido contacto com gato. Objetivamente apresentava-se pálida e ligeiramente prostrada, palpando-se o bordo hepático três centímetros abaixo do rebordo costal direito. Ecograficamente apresentava adenopatias bilaterais cervicais, hepatoesplenomegalia e múltiplas formações nodulares hepáticas hipoecogénicas. A serologia para BH veio confirmar o diagnóstico. Após 37 dias de internamento, houve melhoria do volume das adenopatias e da sintomatologia pelo que a criança teve alta clínica.
Bartonella henselae (BH) was first described about forty years ago. Initially known as the causative agent of cat scratch disease, it is today, mainly due to the development of complementary diagnostic methods, responsible for numerous systemic manifestations with organic affection. Although its clinical incidence is low, it has shown a growing trend. Of the systemic manifestations with organ involvement, one of the most prominent is hepatosplenic disease, characterized by the existence of hepatic and/or splenic microabscesses, which translated in the histologic exam as granulomas with a necrotic center. The treatment of systemic forms of BH infection remains controversial, given its generally benign course. The present work reflects on the case of a 3-year-old child who presents with prolonged fever, associated with bilateral cervical lymphadenopathies and hepatosplenomegaly. Improvement was not verified after numerous antibiotics, having been referred contact with a cat later on. At clinical examination he appeared pale and lightly prostrated, with a palpable hepatic board three centimeters below the right costal grid. Ultrasonography exams revealed bilateral cervical lymphadenopathies, hepatosplenomegaly and multiple hypoechoic nodular formations in the liver. Serology for BH confirmed the acute infection. After 37 days of hospitalization there was improvement of the lymphadenopathies volume and of the symptomatology, with hospital discharge.
Bartonella henselae (BH) was first described about forty years ago. Initially known as the causative agent of cat scratch disease, it is today, mainly due to the development of complementary diagnostic methods, responsible for numerous systemic manifestations with organic affection. Although its clinical incidence is low, it has shown a growing trend. Of the systemic manifestations with organ involvement, one of the most prominent is hepatosplenic disease, characterized by the existence of hepatic and/or splenic microabscesses, which translated in the histologic exam as granulomas with a necrotic center. The treatment of systemic forms of BH infection remains controversial, given its generally benign course. The present work reflects on the case of a 3-year-old child who presents with prolonged fever, associated with bilateral cervical lymphadenopathies and hepatosplenomegaly. Improvement was not verified after numerous antibiotics, having been referred contact with a cat later on. At clinical examination he appeared pale and lightly prostrated, with a palpable hepatic board three centimeters below the right costal grid. Ultrasonography exams revealed bilateral cervical lymphadenopathies, hepatosplenomegaly and multiple hypoechoic nodular formations in the liver. Serology for BH confirmed the acute infection. After 37 days of hospitalization there was improvement of the lymphadenopathies volume and of the symptomatology, with hospital discharge.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Bartonella henselae Doença da arranhadela do gato Febre de origem indeterminada Manifestações hepatoesplénicas Pediatria