Embolia séptica pulmonar – A propósito de um caso clínico
Septic pulmonary embolism – Case report
Luís Coentrão1,, , Jorge Oliveira2, Doutor Paulo Bettencourt3
1 Interno do Internato Complementar de Nefrologia
2 Assistente Hospitalar de Medicina Interna
3 Hospital S. João, Porto, Serviço de Medicina Interna
Received 12 March 2008, Accepted 17 June 2008
Resumo

A embolia séptica pulmonar (ESP) é frequentemente a apresentação clínica de variadas doenças de etiologia infecciosa, por vezes subdiagnosticadas na prática clínica. 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 síndroma sofreu alterações relevantes. No entanto, carece a existência na literatura de critérios de diagnóstico de ESP validados. Os autores apresentam um caso clínico de endocardite infecciosa da válvula tricúspide em toxicodependente, cuja forma de apresentação foi a ESP. O doente apresentava sintomas constitucionais e 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-sensível. O doente realizou antibioterapia dirigida com sucesso terapêutico.

Perante estes achados clínicos e após revisão da literatura, os autores propõem critérios de diagnóstico de ESP.

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.

Palavras-chave
Embolia séptica pulmonar, endocardite infecciosa, infiltrados pulmonares
Key-words
Septic pulmonary embolism, infectious endocarditis, pulmonary infiltrates
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Correspondência: Faculdade de Medicina da Universidade do Porto, Instituto de Farmacologia e Terapêutica Al. Prof. Hernâni Monteiro 4200-319 Porto.
Copyright © 2008. Sociedade Portuguesa de Pneumologia

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