Abstract
OBJETIVO: Descrever uma apresentação atípica de abscesso hepático em paciente pediátrico e realizar uma revisão da literatura no que diz respeito às diferenças observadas na etiopatogenia do quadro, quando considerados os países desenvolvidos e aqueles em desenvolvimento. DESCRIÇÃO DO CASO: Paciente de 13 anos, do sexo masculino, foi trazido ao pronto-socorro pediátrico devido à febre diária e à perda de peso, sem alterações ao exame físico. Na investigação realizada, o ultrassom abdominal evidenciou área heterogênea nodulariforme relativamente definida, compatível com abscesso hepático. Foi realizada drenagem cirúrgica e antibioticoterapia. No material da drenagem houve crescimento de Staphylococcus aureus sensível à oxacilina. COMENTÁRIOS: O caso demonstra a importância de o pediatra conhecer as principais causas da febre de origem indeterminada, saber desenvolver a abordagem investigativa e, frente ao diagnóstico de abscesso hepático, aferir a possibilidade de o agente etiológico ser o Staphylococcus aureus, principalmente quando houver relato de rotura da pele.
Highlights
Liver abscesses, at a rate of 2.3 to 20 cases per 100,000 inhabitants[1,2,3], are relatively rare in the general population
The epidemiology of liver abscesses in developing countries is different from that seen in developed countries, where it is rare and usually associated with a primary disease that results in immunodepression, such as chronic granulomatous disease
A recent study in the United Kingdom reported on the occurrence of 15 cases of pyogenic liver abscess in ten years, and in 20% of the cases the liver abscess was the first sign of chronic granulomatous disease[6]
Summary
To describe the clinical presentation of an atypical liver abscess in the pediatric setting and to conduct a review of the literature concerning ethiopathogenic differences between developed and developing countries. The patient was found to have a well-defined heterogeneous nodular area in the abdominal ultrasonography exam, which was compatible with liver abscess. He was subsequently submitted to surgical drainage and started on antibiotics. Comentarios: El caso demuestra la importancia del pediatra en conocer las principales causas de fiebre de origen indeterminado, en saber desarrollar un acercamiento investigativo y, frente al diagnóstico de absceso hepático, estimar la posibilidad de que el agente etiológico sea el Staphylococcus aureus, principalmente cuando haya relato de rotura de la piel. Palabras clave: absceso hepático; fiebre de causa desconocida; Staphylococcus aureus
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