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PENFIGÓIDE BENIGNO COM MANIFESTAÇÃO BUCAL E OCULAR
RELATO DE CASO
Luhana GedozKaren Loureiro Weigert
Rubem Beraldo dos SantosPaulo Renato Bissacotti
UNIVERSIDADE LUTERANA DO BRASILCAMPUS CACHOEIRA DO SUL
SERVIÇO DE ESTOMATOLOGIA
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RELATO DO CASOAnamnese
- Mulher, 68 anos, leucoderma, freira.
- História médica atual: Osteopenia (Carbonato de Cálcio - 600mg/dia)
- Queixa da doença atual: feridas na boca há 6 meses, sangramento nasal e anal, perda de 15 kg.
- Tratamento prévio: Tratamento tópico fitoterápico. Antibioticoterapia (paciente não soube relatar qual).
- Exame físico extra-bucal: ausência de alterações.
- Exame físico intra-bucal
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Exames Complementares
- Hemograma: leucocitose (linfócitos).
- Biópsia – exame histopatológico HE e Imunofluorescência.
Hipóteses de diagnóstico: Penfigóide benigno e Pênfigo vulgar
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Aspecto microscópico - HE
Presença de clivagem subepidérmica, com infiltrado inflamatório
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Imunofluorescência direta da mucosa perilesional com depósito de C3 e IgG na zona da membrana basal.
Aspecto microscópico - Imunofluorescência
Diagnóstico: Penfigóide benigno
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Exames Complementares
Encaminhamento geriatra
- Endoscopia digestiva alta: Lesões erosionadas com base eritematosa, na altura do esfíncter superior do esôfago.
- Rinoscopia : Lesões crostosas em vestíbulo nasal à direita.
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CONDUTA MULTIDISCIPLINAR
- Eritromicina suspensão oral 2,5% - bochechos 2 vezes ao dia.
- Prednisona 40 mg/dia.
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ACOMPANHAMENTO
-Tratamento homeopático – suspensão do corticóide
Exacerbação do quadro clínico
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MANIFESTAÇÃO OCULAR
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MANIFESTAÇÃO CUTÂNEA
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CONDUTA
- Encaminhamento ao oftalmologista – colírio com corticóide – estágio I de Foster.
- Eritromicina suspensão oral 2,5% - bochechos 2 vezes ao dia
- Prednisona 40 mg/dia.
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2 meses após início da segunda fase do tratamento - 15 mg de Prednisona.
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ACOMPANHAMENTO
- Prednisona 5 mg/dia
- Colírio com corticóide- Colírio lubrificante - Oftane
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CONSIDERAÇÕES FINAIS
- Importância do acompanhamento clinico
Curso clínico instável
- Importância da abordagem multidisciplinar
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OBRIGADO!
Luhana GedozMestre em Patologia Bucal – UFRGS
Professora da Ulbra – Cachoeira do [email protected]