1 - Unidade de Infecciologia. Área da Mulher Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central – EPE
2 - Unidade de Neurologia Pediátrica, Área da Mulher Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central – EPE
3 - Unidade de Reumatologia Pediátrica, Área da Mulher Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central – EPE
- 10th Excellence in Pediatrics Conference, PragaRepúblicaCheca, 2018
Resumo:
Introdução: Orbital myositis is an inflammatory disease of extraocular muscles. It is quite rare in children and may be oligosymptomatic or severe (in this case with ptosis and proptosis). Although the majority are idiopathic, it may be associated with systemic disorders, and some forms have been associated with infectious diseases, such as streptococcal pharyngitis.
Relato de Caso: A 14-year-old boy was admitted with pain on the right eye, diplopia, proptosis and ptosis with one-week evolution and progressive deterioration. He had no fever or other symptoms. Two years prior he had a similar episode, treated with steroids. He had a history of recurrent episodes of tonsillitis. CT showed enlargement of the rectus superior and right eyelid and enlargement of the periorbital muscles on the left eye. His complete blood count was normal, CRP 0.8g/L, ASO titter 1200 UI/ml and anti-Dnase B Ab 824 UI/ml. The remaining work-up was normal. 11 months later he presented with periorbital swelling of the left eye, pain with eye movements and diplopia. The throat was hyperaemic. CT showed enlargement of the small obliquus muscle. Rapid antigen detection for group A streptococcus was positive and he was given with intramuscular penicillin injections (1200000UI) and metiprednisolonepulses. He started monthly penicillin prophylaxis without new episodes of myositis. Additionally, tonsillectomy was performed in July 2018 with pathology report of the tonsils revealing bacterial aggregates on the tonsillar crypts.
Conclusão: We describe recurrent orbital myositis associated with serological evidence of recent streptococcal infection. This case suggests a possible post-streptococcal immune mechanism for this disease. As other manifestations of the post-streptococcal syndrome, orbital myositis appears to have an immune mechanism of lesion an, as such, could be explained in this context.
Palavras Chave: Orbital myositis, relapsing, streptoccocal infection