{"id":4137,"date":"2021-03-09T09:00:44","date_gmt":"2021-03-09T09:00:44","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/caso-clinico-mucormicose-gastrica\/"},"modified":"2022-05-26T23:24:44","modified_gmt":"2022-05-26T23:24:44","slug":"caso-clinico-mucormicose-gastrica","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/caso-clinico-mucormicose-gastrica\/","title":{"rendered":"Caso cl\u00ednico \u2013 mucormicose g\u00e1strica"},"content":{"rendered":"

Paciente masculino, 62 anos, sem comorbidades, v\u00edtima de ferimento por proj\u00e9til de arma de fogo (PAF) em membro superior direito e hemit\u00f3rax, submetido \u00e0 toracotomia direita e \u00e0 laparotomia com rafias diafragm\u00e1tica e hep\u00e1tica, sem intercorr\u00eancias. Evoluiu com epis\u00f3dios de v\u00f4mitos com rajas de sangue no p\u00f3s-operat\u00f3rio, sendo realizada <\/span>endoscopia<\/span><\/a> para investiga\u00e7\u00e3o diagn\u00f3stica.<\/span><\/p>\n

Identificadas as seguintes imagens:<\/span><\/p>\n

\"Mucormicose<\/a>\"Mucormicose<\/a>\"Mucormicose<\/a>\"Mucormicose<\/a><\/p>\n

Realizadas bi\u00f3psias que evidenciaram numerosas hifas f\u00fangicas sugestivas de mucormicose.<\/span><\/p>\n

Introduzido anfotericina B lipossomal e, ap\u00f3s seis dias, foi realizada cirurgia para ressec\u00e7\u00e3o em cunha da les\u00e3o. Foi feita uma endoscopia intraoperat\u00f3ria que revelou consider\u00e1vel melhora no aspecto da les\u00e3o.<\/span><\/p>\n

\"Mucormicose<\/a>\"Mucormicose<\/a><\/p>\n

Revis\u00e3o<\/h2>\n

A mucormicose \u00e9 uma infec\u00e7\u00e3o f\u00fangica oportunista, potencialmente fatal, causada por fungos da ordem <\/span>Mucorales.<\/span><\/i> Ocorre mais comumente em pacientes imunocomprometidos, como em diab\u00e9ticos descompensados (principal fator de risco), queimados, desnutridos, com neoplasias hematol\u00f3gicas, transplantados, em uso de corticoesteroides, com insufici\u00eancia renal, uso de antif\u00fangicos, terapia com desferroxamina, antibioticoterapia de amplo espectro, consumo de drogas intravenosas e ruptura cut\u00e2nea traum\u00e1tica, como na perfura\u00e7\u00e3o por arma de fogo. No entanto, nos \u00faltimos anos, a doen\u00e7a tamb\u00e9m tem sido cada vez mais descrita em pacientes imunocompetentes.<\/span><\/p>\n

Sua apresenta\u00e7\u00e3o cl\u00ednica \u00e9 heterog\u00eanea, variando de acordo com o s\u00edtio da infec\u00e7\u00e3o. As formas mais frequentes s\u00e3o: seios da face (39%), pulmonar (24%), cut\u00e2neo (19%), cerebral (9%), gastrointestinal (7%), disseminada (3%) e renal (2%).<\/span><\/p>\n

A mucormicose gastrointestinal \u00e9 rara, e as manifesta\u00e7\u00f5es variam desde a coloniza\u00e7\u00e3o de \u00falceras p\u00e9pticas \u00e0 doen\u00e7a infiltrativa com invas\u00e3o e dissemina\u00e7\u00e3o vascular. No envolvimento gastrointestinal, o \u00f3rg\u00e3o mais frequentemente comprometido \u00e9 o est\u00f4mago (58%), seguido pelo c\u00f3lon (32%), intestino delgado e es\u00f4fago. Acarreta uma taxa de mortalidade significativa, alcan\u00e7ando at\u00e9 85%, isso devido ao atraso no diagn\u00f3stico e a complica\u00e7\u00f5es, como perfura\u00e7\u00e3o e sangramento maci\u00e7o. Na endoscopia, geralmente, pode-se observar \u00falcera solit\u00e1ria ou m\u00faltiplas, recobertas por tecido necr\u00f3tico. O diagn\u00f3stico \u00e9 confirmado histopatologicamente com base na bi\u00f3psia da \u00e1rea suspeita durante cirurgia ou endoscopia.<\/span><\/p>\n

Ainda n\u00e3o est\u00e1 claro como os <\/span>Mucorales<\/span><\/i> colonizam e invadem o trato gastrointestinal, mas alguns autores sugerem a ingest\u00e3o de alimentos, como leite fermentado, produtos de panifica\u00e7\u00e3o e mingaus fermentados, bebidas alco\u00f3licas preparadas do milho, medicamentos fitoter\u00e1picos e homeop\u00e1ticos, contendo esporos desse pat\u00f3geno.<\/span><\/p>\n

O manejo bem-sucedido da mucormicose inclui suporte metab\u00f3lico agressivo, terapia antif\u00fangica com anfotericina B ou posaconazol e desbridamento cir\u00fargico de todos os tecidos envolvidos com necrose. A dura\u00e7\u00e3o do tratamento \u00e9 individualizada, mas, geralmente, \u00e9 mantida por 4 a 6 semanas.<\/span><\/p>\n

Como citar este artigo:<\/h3>\n

Fagundes M. Caso Cl\u00ednico \u2013 Mucormicose g\u00e1strica. Endoscopia Terap\u00eautica; 2021. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/caso-clinico-mucormicose-gastrica\/<\/span><\/p>\n

Refer\u00eancias bibliogr\u00e1ficas:<\/h3>\n
    \n
  1. Abreu, BFBB et al. A rare case of gastric mucormycosis in an immunocompetent patient. Rev Soc Bras Med Trop 51(3):401-402, May-June, 2018.<\/span><\/li>\n
  2. Kaur, H, et al. Gastrointestinal mucormycosis in apparently immunocompetent hosts\u2014A review. Mycoses. <\/span>May 2018.<\/span><\/li>\n
  3. Spellberg, B, et al. Gastrointestinal Mucormycosis: An Evolving<\/li>\n<\/ol>\n

    Acesse o <\/span>Endoscopia Terap\u00eautica<\/span><\/a> para tomar contato com mais <\/span>artigos comentados<\/span><\/a>, <\/span>assuntos gerais<\/span><\/a>, <\/span>casos cl\u00ednicos<\/span><\/a>, <\/span>quizzes<\/span><\/a>, <\/span>classifica\u00e7\u00f5es<\/span><\/a> e mais!<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

    Paciente masculino, 62 anos, sem comorbidades, v\u00edtima de ferimento por proj\u00e9til de arma de…<\/p>\n","protected":false},"author":3411,"featured_media":4131,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[262],"tipo":[153],"volume":[263],"class_list":["post-4137","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-262","tipo-endoscopia-digestiva-alta","volume-volume-i"],"yoast_head":"\nCaso cl\u00ednico \u2013 mucormicose g\u00e1strica • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/caso-clinico-mucormicose-gastrica\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta 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