Suplemento Vol.76 (5) Set./Out. 2010
RELATO DE CASO (APENAS APRESENTAÇÃO COMO PÔSTER)
P-389
TÍTULO: LEMIERRE ASOCIATED TO GRISEL SYNDROME IN A PEDIATRIC PATIENT
AUTOR(ES): ESTEBAN ESPÍNOLA , ARIAS JORGE, QUIROZ JOSÉ, PEREZ ENRIQUE, MEDINA ANDRÉS, ALARCÓN LETICIA, LIU TA
INSTITUIÇÃO: CLINIC HOSPITAL U.N.A. ASUNCION PARAGUAY
Lemierre´s Syndrome, a rare and forgotten entity described by Lemierre in 1936 in his 20 cases of thrombophlebitis of the internal jugular vein, anaerobic infections usually caused by head and neck. In partnership with Grisel´s syndrome, an entity described by French otolaryngologist who was named in 1930, represents a rare but clinically well-defined non-traumatic atlantoaxial dislocation secondary to infection nasopharynx, and postoperative otolaryngologist. The association of both syndromes incorporates our case report, which aims to describe aspects of both syndromes in our patient. School male patient aged 12, previously exhibited at another institution by otalgia, bilateral purulent otorrhea, headache, fever, presumably treated as acute otitis media and bacterial meningitis. No injury reported. On physical examination in our state of consciousness is found preserved bilateral mastoid tumor predominantly left-sided left eardrum perforations, neck stiffness, inflammatory lymph nodes in high yugulocarotidea region of approx. 1 cm. Auxiliary Studies show increased number of neutrophils at the expense white, cerebrospinal fluid within limits. Tomographically described sinus veiled support frames rhinosinusal, prevertebral abscess about 2 to 6 cm in diameter at the level of the first to the third cervical vertebrae, atlantoaxial dislocation with cervicofacial right lateralization, which was subsequently shown that joint injury in MRI. The patient remained hospitalized starting Ceftazidime / Oxacillin, including further schemes ciprofloxacin, vancomycin and metronidazole to septic developments including the combination of Ciprofloxacin after / Clindamycin. Cervicotomy is performed for abscess drainage, being during surgery of thrombophlebitis of the internal jugular vein and adenoflemones in yugulocarotideos upper and middle regions. It includes the use of enoxaparin to find. No neurological complication. Polyculture returned negative at all times. Cervical collar is established for maintaining atlantoaxial dislocation, expectations neurosurgery. Patient remains hospitalized with antibiotics for more than 1 month in room with diagnostic pediatric Lemierre´s Syndrome, Syndrome Grisel, otomastoiditis, pansinusitis, sepsis syndrome. Numbers of white blood cells and on the thermal curve were decreased during evolution. Periodic inspections integral between Otolaryngology, Pediatrics and Neurosurgery is set for the discharge. In the pre-antibiotic era Lemierre´s syndrome was high mortality and neurological sequelae rate accentuated later to penicillin that was in decline and the biggest benefit being the use of anticoagulants. Leaving surgery for specific cases. The immobilization, medical treatment, traction and physiotherapy are advocated for Grisel´s syndrome, with surgical reduction and fixation for late cases. The association of both entities has not been reported lately. Regarding the situation seems important to emphasize care specialists in these important institutions and forgotten.
Keywords: Lemierre, Grisel, Syndrome