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- Title
Epistaxes: um desafio para o clínico na busca do prognóstico.
- Authors
Fröhlich Klug, Filipe Simeão; Mambre Bonomo, Carolina Castanho; Silva Zechetto, Leandro; Neves Torres, Luciana; do Vale De Zoppa, André Luiz; Bargi Belli, Carla
- Abstract
Background: Ailments that affect guttural pouches (GPs) include congenital malformations, tumors, and, especially, infections. Clinical signs of disorders of the GPs are not always specific, and include nasal secretion, epistaxis, and enlargement of regional lymph nodes. Deficient diagnosis and treatment tend to limit life expectancy. Some cases can lead to terminal exsanguination due to progression of the disorder if not diagnosed or if treatment fails. Unusual presentations may occur, and these cases require knowledge for prompt action and determination of the prognosis. The objective of this work is to report one of these unusual cases: epistaxis caused by rupture of the GP by a pharyngeal abscess. Case: A 6-year-old mare was presented for examination exhibiting purulent nasal secretion that had been ongoing for approximately 45 days (which had been treated as strangles for 7 days) and intermittent epistaxis for the past 20 days. When the mare was taken to the Veterinary Hospital, it also exhibited dysphagia with purulent nasal secretion mixed with the ingested food, a body condition score of 3/9, wheezing, mild ataxia, anemia (2.8 million RBCs/mm3; hematocrit = 14%), leukopenia (4,600 WBCs/mm3), and hyperfibrinogenemia (600 mg/dL). Upper airway endoscopy revealed presence of blood in the anterior third of the trachea, a blood clot in the left GP, and absence of bacterial of fungal plaques. Analysis of the bloody material collected from the GP showed presence of cocci bacteria and neutrophils. The treatment initially implemented was antibiotic therapy with enrofloxacin. Epistaxis worsened on the day following admission. Blood transfusion was carried out, but this procedure was not effective as profuse acute hemorrhage took place and led to death of the patient 48 h after admission. At necropsy, the left GP was laden with blood clots and serous/bloody content, and exhibited a circular/cylindrical lesion in its retropharyngeal portion. Next to this lesion, between the two GPs, there was a cavity containing blood clots and dense caseous material. Microscopically, coccoid bacterial colonies and degenerated neutrophils immersed in fibrinoid necrotic material were observed. Discussion: Dysphagia, mild ataxia, and epistaxis led to the initial suspicion of involvement of the GP secondary to fungal infection, which is the clinical picture most frequently associated with these clinical signs. Additionally, physical evaluation and complementary exams indicated that the animal also exhibited pneumonia, which suggested possible persistence of strangles in the form of bastard strangles. Endoscopic examination, which should have provided a better idea of the cause of the condition, was not very effective owing to the great amount of blood present in the GP. Therefore, we opted for antibiotic therapy with observation of the evolution of the clinical picture. Unfortunately, the case rapidly progressed to intense nasal bleeding and death of the patient. The cause of epistaxis could be determined only at necropsy: rupture of blood vessels of the left GP wall owing to a pharyngeal abscess located between the two GPs. Reports describing the development of an abscess between the GPs accompanied by lesion of the GP wall and nearby innervation have not been found in the literature. Finding data on some types of conditions can be challenging, and scarcity of reports on disorders of the GPs characterizes a deficit of data, even in specialized centers. Therefore, the case described here presents one more possibility to be considered in cases of epistaxis, especially when associated with a history of strangles.
- Publication
Acta Scientiae Veterinariae, 2018, Vol 46, Issue Suppl, p1
- ISSN
1678-0345
- Publication type
Article