Epistaxes: um desafio para o clínico na busca do prognóstico / Epistaxis: a challenge for clinicians in the search for prognosis

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.[...]