Márcio José de Araújo Torres
Professor Assistente, Livre-Docente, da Disciplina de Clínica Médica do Departamento de Medicina Clínica da Faculdade de Medicina da U.F.F.
RESUMO
O autor descreve 7 casos de piomiosite tropical, enfatizando a exceção que constituem, quando se considera a extrema raridade da supuração muscular em outras doenças e citando várias idéias existentes quanto à sua patogenia.
O quadro clínico dos 7 casos é semelhante à maioria dos já relatados em outros trabalhos, aparecendo entretanto piodermite em 2 doentes, o que não é comum.
A freqüência da eosinofilia e a normalidade de enzimas geralmente elevadas em outras miopatias, estão de acordo com as publicações existentes.
Embora o tratamento seja basicamente cirúrgico, aceita a possibilidade de cura com antibióticos, cujo uso empírico poderia abortar inúmeros casos, contribuindo para o virtual desconhecimento da doença no meio brasileiro. Considera provável ser grande número de doentes tratado como portadores de abscessos como quaisquer outros, sem se atentar para a já referida resistência dos músculos esqueléticos à supuração. Dá importância ao desconhecimento da doença como causa de demora no diagnóstico, com possíveis repercussões no prognóstico.
Esse fato, aliado a semelhanças climáticas de certas regiões brasileiras com zonas africanas onde a incidência é alta, justifica, segundo o autor, maior interesse pela doença.
ABSTRACT
Seven cases of tropical pyomyositis are reported emphasizing the unique character of muscular suppuration, an exceedingly unusual occurrence in other diseases; possible explanations as to the pathogenical mechanismsare reviewed.
Clinical aspects are similar to those of previously described cases but for pyodermitis, an unconmmon feature found in two cases. Eosinophila and normal leveis of serum enzymes usually altered in other muscle diseases are also in accordance to previous papers.
Surgical drainage is the treatment of choice, but the early administration of antibiotics might abort the evolution of many cases; the empirical use of such drugs modifies clinical course and most patients are probably diagnosed as having common muscle abscesses, overlooking the high resistance of skeletal muscles to suppuration. Such features might explain the fact the condition has been virtualy undiagnosed in Brazil.
The delay is making a correct diagnosis might affect the prognosis and this fact, allied to the great similary in environmental conditions between some Brazilian regions and African countries where the disease has been frequently reported, should justify a greater interest in its study.
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Recebido para publicação em 13.9.1977.
* Tese de Livre Docência em Clínica Médica apresentada à Faculdade de Medicina da U.F.F.
