C. Quintela1, N. Marques2, M. J. Bettencourt3, A. Quintino4
Resumo
O sprue tropical é uma síndrome caracterizada por diarreia, perda de peso e malabsorção de nutrientes. Trata-se de um caso de uma mulher, 57 anos, raça negra, natural e residente na Guiné-Bissau, internada para esclarecimento de pan citopenia. Dos antecedentes pessoais destaca-se: Malária, Sífilis e infestação crónica por Entamoeba histolytica. No exame objectivo salienta-se: mucosas descoradas, glossite. La boratorialmente verifica-se: pancitopénia, défice de vitamina B12 e ácido fólico. A pesquisa de quistos, ovos e parasitas nas fezes mostra: quistos de Entamoeba histolytica. A endoscopia digestiva alta revela: gastrite erosiva. A histologia duodenal: atrofia vilositária e infiltrado intraepitelial e linfoplasmocitário no corion sugestivo de sprue tropical. Me dicada com cianocobalamina, ácido fólico e metronidazolcom resolução clínica, laboratorial, endoscópica e histológica.
Summary
Tropical sprue is characterized by diarrhea, weight loss and malabsortion. The authors describe a case of a 57-years old black woman resident in Guinea-Bissau admitted to the hospital due to pancytopenia. She had a history of malaria, syphilis and recurrent parasitic infections with Entamoeba histolytica. Physical examination showed pale mucosa and glossitis. Laboratory revealed: pancytopenia, low folic acid and vitamin B12. In the stools cysts of Entamoeba histolytica were isolated. Upper endoscopy showed diffuse erosive gastritis. Histologic examination of biopsies taken in the stomach showed villous atrophy and inflammatory infiltration with lymphocytes and plasmocytes both intraepithelial and in the corion, compatible with tropical sprue. After treatment with metronidazol, folic acid and vitamin B12 there was clinical, laboratory, endoscopic and histological improvement.
]]>
Texto Completo disponível apenas em PDF
Full text only available in PDF format
Bibliografia
1. Feldman M., Friedman L., Brandt L.; Sleisenger and Fortran’s Gastrointestinal and Liver disease 8th edition; vol. 2; pg 2311-16.
2. Westergaard H. Tropical sprue. Curr Treat Options Gastroenterol. 2004; 7: 7-11.
]]> 3. Glynn J. Tropical sprue-its aetiology and pathogenesis. J R Soc Med. 1986; 79: 599-606.4. Tropical sprue [internet] 2006; [update 2006 March 13]. Available in http://emedicine.com.
5. Lim, ML. A perspective on tropical sprue. Current Gastroent Rep 2001; 3:322-7.
6. Bourée P. Tropical sprue. Presse Med. 2007; 36: 723-6.
7. Rajendra S, Baharain SRK, Karim N, Ho JJ, Kutty K. Ethnic disparity in the prevalence of partial villous atrophy and post-infective tropical malabsortion. letters to editor: 472-4.
8. Owens SR, Greeson JK. Pathology of malabsortion: Current concepts. Histopathology 2007;50:64-82.
9. Bayless TM, Wheby MS, Swanson VL. Tropical sprue in Puerto Rico. Am J Clin Nutric 1986; 2i: 1030-1041.
10. Falaiye JM. Present status of subclinical intestinal malabsorption in the tropics. Brit Med J 1971; 4: 454-8.
11. Cook GC. Aetiology and pathogenesis of postinfective tropical malabsorption (tropical sprue). Lancet 1984;1: 721-3.
12. Halfdanarson TH, Litzow MR, Murray JR. Hematologic manifestations of celiac disease. Blood 2007;109: 412-421.
]]> 13. Morson BC, Dawson IM, Day DW, Jass JR, Price AB, Williams GT. Morson & Dawson’s Gastrointestinal Pathology. 3rd edition; pgs 322-323.
(1) Interna do Internato Complementar de Gastrenterologia.
(2) Interna do Internato Complementar e Medicina Interna.
(3) Assistente Graduada de Gastrenterologia.
(4) Assistente Graduada de Medicina Interna.
Serviço de Gastrenterologia, Centro Hospitalar de Lisboa Central – Hospital de Santo António dos Capuchos, Lisboa, Portugal.
Serviço de Medicina Interna, Centro Hospitalar de Lisboa Central – Hospital de Santa Marta, Lisboa, Portugal.
]]> Correspondência:
Cátia Quintela
Serviço de Gastrenterologia - Hospital de Santo António dos Capuchos
Alameda de Santo António dos Capuchos
1150 Lisboa
Tlm: 918906762
e-mail: catia_quintela@iol.pt
Recebido para publicação: 22/10/2007
]]> Aceite para publicação: 16/07/2008 ]]>