{"id":4155,"date":"2021-05-07T09:00:35","date_gmt":"2021-05-07T09:00:35","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/esofagite-herpetica-em-paciente-imunocompetente-um-relato-de-caso\/"},"modified":"2022-07-11T07:47:24","modified_gmt":"2022-07-11T07:47:24","slug":"esofagite-herpetica-em-paciente-imunocompetente-um-relato-de-caso","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/esofagite-herpetica-em-paciente-imunocompetente-um-relato-de-caso\/","title":{"rendered":"Esofagite herp\u00e9tica em paciente imunocompetente: um relato de caso"},"content":{"rendered":"

Autores<\/strong>: Nathan Uehara Lira; Leonardo Oba; Cl\u00f3vis Kuwahara; Ricardo Papi; Maria Fernanda Luchetti; Carina Fava; Isabelle Kristal.<\/span><\/p>\n

Em geral, a infec\u00e7\u00e3o esofagiana pelo HSV pode ser consequ\u00eancia de v\u00e1rios eventos: contamina\u00e7\u00e3o pela orofaringe; reativa\u00e7\u00e3o do v\u00edrus; dissemina\u00e7\u00e3o para mucosa esof\u00e1gica por meio do nervo vago.<\/span><\/p>\n

Em pacientes imunocompetentes, a infec\u00e7\u00e3o \u00e9 autolimitada. As principais manifesta\u00e7\u00f5es cl\u00ednicas s\u00e3o: <\/span>disfagia<\/span><\/a> e odinofagia (85%), dor tor\u00e1cica (68%) e febre (44%). Tamb\u00e9m foram descritos n\u00e1useas e v\u00f4mitos em 15% dos casos e associa\u00e7\u00f5es com les\u00f5es orais em 29%. H\u00e1 tamb\u00e9m relatos de hemorragia digestiva (5,3%).<\/span><\/p>\n

Ao exame endosc\u00f3pico, as les\u00f5es esof\u00e1gicas pelo HVS s\u00e3o localizadas no ter\u00e7o distal (50%), podendo ser encontradas em outros setores ou eventualmente serem difusas (32%). Inicialmente, apresentam-se como ves\u00edculas, medindo de 1 a 3 mm, localizadas principalmente em ter\u00e7o m\u00e9dio e distal do es\u00f4fago, podendo haver descama\u00e7\u00e3o com forma\u00e7\u00e3o de pequenas \u00falceras de 1 a 3mm, que podem ser descritas como superficiais ou estelares com fundo eritematoso, edema ou eritema. Existem tamb\u00e9m algumas formas especiais com aspecto de vulc\u00e3o. Eventualmente, \u00e9 observada a presen\u00e7a de pseudomembranas, lembrando candid\u00edase esof\u00e1gica. As \u00falceras herp\u00e9ticas podem evoluir com estenoses ou f\u00edstulas. As margens das \u00falceras devem ser biopsiadas ou pode ser realizado um escovado para citologia.<\/span><\/p>\n

Descri\u00e7\u00e3o do caso<\/b><\/h2>\n

Paciente masculino, 19 anos, vem ao consult\u00f3rio apresentando queixas de epigastralgia e disfagia para s\u00f3lidos e l\u00edquidos com in\u00edcio h\u00e1 dois dias. Apresentou um epis\u00f3dio de v\u00f4mitos com vest\u00edgios hem\u00e1ticos. Sem febre. Estava em uso de azitromicina e prednisona para tratamento de uma faringite.<\/span><\/p>\n

Ap\u00f3s a consulta, foi solicitada uma <\/span>endoscopia<\/span><\/a>, na qual visualizamos estas imagens:<\/span><\/p>\n

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

Coletadas bi\u00f3psias das bordas das les\u00f5es.<\/span><\/p>\n

Anatomopatol\u00f3gico: <\/span>esofagite<\/span><\/a> cr\u00f4nica, moderada e erosiva, com presen\u00e7a de inclus\u00f5es nucleares com caracter\u00edsticas de herpes.<\/span><\/p>\n

Conclus\u00e3o<\/b><\/h2>\n

Esofagite herp\u00e9tica<\/span><\/a> \u00e9 uma altera\u00e7\u00e3o rara de ser encontrada em pacientes imunocompetentes, e seu diagn\u00f3stico depende de uma endoscopia digestiva alta<\/a> com coleta de material para bi\u00f3psia. O tratamento \u00e9 realizado com aciclovir, e alguns artigos citam apenas tratamento de suporte por ser uma infec\u00e7\u00e3o autolimitada. Ent\u00e3o, \u00e9 muito importante que os endoscopistas tenham conhecimento da condi\u00e7\u00e3o, n\u00e3o deixando passar seu diagn\u00f3stico e evitando assim suas poss\u00edveis complica\u00e7\u00f5es.<\/span><\/p>\n

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

Lira NU., Oba L., Kuwahara C., Papi R., Luchetti MF., Fava C., Kristal I. Esofagite herp\u00e9tica em paciente imunocompetente: um relato de caso. Endoscopia Terap\u00eautica; 2021. Dispon\u00edvel em: https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/esofagite-herpetica-em-paciente-imunocompetente-um-relato-de-caso<\/span><\/p>\n

Confira tamb\u00e9m: <\/b>Esofagite por c\u00e2ndida \u2013 Kodsi<\/a><\/p>\n

Bibliografia<\/b><\/h3>\n
    \n
  1. SAKAI, Paulo. Tratado de Endoscopia Digestiva Diagn\u00f3stica e Terap\u00eautica. 3\u00aa Edi\u00e7\u00e3o. Editora Atheneu.<\/span><\/li>\n
  2. PINHEIRO, Mariana. Herpetic Esophagitis: A diagnosis to remember. Birth and Grow Medical Journal. Volume 24 N\u00ba1. 2015.<\/span><\/li>\n
  3. MENDES, Lucas Corr\u00eaia. Esofagite herp\u00e9tica em crian\u00e7a imunocompetente. The Brazilian Journal of Infectious diseases. Volume 25. 2021.<\/span><\/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

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Autores: Nathan Uehara Lira; Leonardo Oba; Cl\u00f3vis Kuwahara; Ricardo Papi; Maria Fernanda Luchetti; Carina…<\/p>\n","protected":false},"author":3759,"featured_media":4153,"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-4155","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-262","tipo-endoscopia-digestiva-alta","volume-volume-i"],"yoast_head":"\nEsofagite herp\u00e9tica em paciente imunocompetente: um relato de caso • 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\/esofagite-herpetica-em-paciente-imunocompetente-um-relato-de-caso\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Esofagite herp\u00e9tica em paciente imunocompetente: um relato de caso\" \/>\n<meta property=\"og:description\" content=\"Autores: Nathan Uehara Lira; Leonardo Oba; Cl\u00f3vis Kuwahara; Ricardo Papi; Maria Fernanda Luchetti; Carina Fava; Isabelle Kristal. 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