LA. Costa Barra; W. Ferreira dos Santos; P.P. Chieffi; E.A. Bedaque; P.S. Campos Salles; C.G. Capitão; S. Vianna, R. Hanna; L. Pedretti Júnior
Instituto de Infectologia Emílio Ribas, Instituto de Medicina Tropical de São Paulo, São Paulo, SP e Hospital de Ease de Rio Branco, Rio Branco,AC.
RESUMO
Relatamos o caso de um paciente do sexo mascidino, dezoito anos de idade, procedente de Xapuri no Estado do Acre (Brasil), com história de episódios repetidos de meningoencefalites (três num ano), acompanhadas no local de origem. Em nosso serviço, no Instituto de Infectologia Emílio Ribas, obsewamos um quadro de poliartralgias, alterações radiológicas e broncoscópicas pulmonares e sinais neurológicos de irritação tneníngea e de comprometimento do tronco-encefãlico (com tomografia axial de crânio e exames liquóricos normais), acompanhando-se de eosinofilia periférica e títulos sorológicos elevados para Toxocara canis (EIISA). Consubstanciada a hipótese diagnostica de toxocaríase (larva migrans visceral – IMV), procedeu-se ao tratamento com tiabendazol, ocorrendo remissão clínica e laboratorial completa. Um mês após, ocorreu novo episódio de cefaléia acompanhada por rigidez de nuca (que remitiu em três dias com dexametasona) e, a partir daí, não mais obsewamos quaisquer alterações clínicas ou laboratoriais em cerca de três anos e meio de acompanhamento ambulatorial.
Palavras-chaves: Larva migrans visceral. Toxocara canis. ELISA. Tiabendazol.
ABSTRACT
We relate a case of an 18-year-old man, resident of Xapuri (State of Acre, Brazil), with a history of repeated episodes of meningoencephalitis (three in one year), each one was examined by a local doctor. In our service (Emilio Ribas Institute of Infectology) we observed a patient with polyjoint aches, radiological and broncoscopical pulmonary alterations (without clinical features), meningeal and brain stem manifestations — with normal brain computed tomography and cerebrospinal fluid. Blood eosinophils and serological Toxocara canis test (ELISA) were greatly increased. With the hipothesis of Toxocariasis (Visceral Lana Migrans) we administered Thiabendazole that brought complete clinical and laboratorial remission. Lnspite of a new episode of headache with meningeal manifestation approximately one month later (treated with dexamethasone resulting in a full remission after three days) we have not finded other manifestations in approximately three and a half years of ambulatory’ care.
Keywords: Visceral lawa migrans. Toxocara canis. ELISA. Thiabendazole.
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Recebido para publicação em 25/04/95.
Instituto de Infectologia Emílio Ribas, Instituto de Medicina Tropical de São Paulo, São Paulo, SP e Hospital de Ease de Rio Branco, Rio Branco,AC.
Endereço para correspondência:
Dr. Luiz Alberto Costa Barra.
Instituto de Infectologia Emílio Ribas.
Av. Dr. Arnaldo 165, 1o Andar, 01246-090
São Paulo, SP, Brasil.
Fax: (011) 280-3954.
