Abcessos cerebrais múltiplos – Uma complicação rara de bronquiectasias

 

Natália Melo 1

Vicens Diaz -Brito 2

Clara Chamadoira 3

Isabel Gomes 4

Adelina Amorim 5

 

 

Resumo

Introdução: O abcesso cerebral (AC) pode surgir como complicação de uma grande variedade de infecções, traumatismos ou cirurgias. Os microrganismos podem atingir o cérebro por contiguidade ou por disseminação hematogénea. Os AC estão descritos como uma complicação rara de bronquiectasias (BQ).

Caso clínico: Mulher de 44 anos com história de tuberculose pulmonar na infância e com diagnóstico de BQ bilaterais extensas que apresentou alterações do comportamento e posteriormente paresia do 6.º nervo craniano esquerdo, tendo sido diagnosticados AC múltiplos. O estudo microbiológico exaustivo foi negativo.

A pesquisa de focos de infecção primária revelou apenas a presença de BQ infectadas. Efectuou tratamento antibiótico empírico e antiedematoso, com melhoria clínica progressiva. Contudo, por persistência das lesões cerebrais, foi submetida a excisão cirúrgica dos AC. Teve alta com diplopia, sem outras alterações neurológicas.

Conclusão: No presente caso clínico, as BQ foram o único foco de infecção detectado, motivo pelo qual, nos doentes com esta patologia e com alterações neurológicas de novo, deverá ser pesquisada a existência de lesões infecciosas do sistema nervoso central.

Palavras -chave: Bronquiectasias, abcesso cerebral

 

 

Multiple brain abscesses – A rare complication of bronchiectasis

Abstract

Background: Brain abscess can arise as a complication of a variety of infections, trauma or surgery. Bacteria can invade the brain by direct spread or through haematogenous seeding. Brain abscesses are described as a rare complication of bronchiectasis.

Case description: A 44 -year -old woman with pulmonary tuberculosis in childhood and with the diagnosis of bilateral extensive bronchiectasis who presented behaviour alterations and later, paresis of the sixth cranial nerve, was diagnosed multiple brain abscesses.

The microbiological exams were negative. The study of the primary focus of infection could only identify infected bronchiectasis. Empiric antibiotics and anti-      -oedematous treatment were prescribed with progressive clinical improvement. Because of inadequate response she was submitted to surgery. She was discharged with diplopia, without any other neurological alterations.

Conclusion: In the present clinical case, the infected bronchiectasis were the only focal infection detected, so in patients with this disease and with new neurological manifestations, infected lesions in the central nervous system should be excluded.

Key-words: Bronchiectasis, brain abscess

 

 

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1 Interna Complementar de Pneumologia – Serviço de Pneumologia – Director de Serviço: Prof. Dr. Venceslau Hespanhol

2 Assistente Hospitalar de Doenças Infecciosas – Serviço de Doenças Infecciosas – Director de Serviço: Prof. Dr. António Sarmento

3 Interna Complementar de Neurocirurgia – Serviço de Neurocirurgia – Director de Serviço: Prof. Dr. Rui Vaz

4 Assistente Hospitalar Graduada de Pneumologia – Serviço de Pneumologia

5 Assistente Hospitalar de Pneumologia – Serviço de Pneumologia

Hospital de S. João, Porto

 

Correspondência/Correspondence to:

Natália Melo

Serviço de Pneumologia, Hospital de S. João

Alameda Professor Hernâni Monteiro

4202 -451 Porto

Telefone: 919371855

e -mail: nataliafmelo@hotmail.com

 

 

Recebido para publicação/received for publication: 08.08.26

Aceite para publicação/accepted for publication: 08.12.15