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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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RECURRENT ORBITAL MYOSITIS AND STREPTOCOCCAL INFECTION

Tânia Mendo1, José Pedro Vieira2, Maria João Brito1

1 - Unidade de Infecciologia, Área da Mulher, Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa
2 - Serviço de Neuropediatria, Área da Mulher, Criança e Adolescente, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa

- Apresentado sob a forma de E-Poster no 10th Congress of the World Society for Pediatric Infectious Diseases (WSPID 2017), in Shenzhen, China, December 2-5, 2017

Introduction: 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). The etiology often remains unknown.
Case Description: A 14-year-old male had orbital myositis two years earlier and was treated with corticosteroid therapy with benefit. He also had a history of recurrent and frequent episodes of tonsillitis. He presented to the Emergency Department with ocular pain that worsened with eye movements, unilateral ptosis, proptosis and vertical diplopia with one week of evolution. Neurologic examination was otherwise normal. He reported tonsillitis not treated with antibiotics two weeks before this episode. The CT scan showed thickening of the rectus and levator palpebrae muscles of the right orbit with heterogeneity of the retrobulbar fat tissue and thickening of the rectus of the left eye. The autoimmunity study was normal and the serological investigation confirmed streptococcal antecedent infection with anti-streptolysin O titer (ASLO) 1200UI/ml and Dnase B 824UI/ml. He was medicated with cefuroxime and prednisolone with a favorable evolution. Two months later ASLO values were 781UI/ml and DnaseB values were 688UI/ml, the decrease in antibody titers confirmeda previous acute infection.
Comments: We describe orbital myositis associated with serological evidence of recent streptococcal infection and no other etiology documented. 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, streptococcal infection