Bite of Canis lupus familiaris in an infant causing skull injury and neurological sequelae

In most cases of dog bites, there are low-risk injuries. However, more serious injuries may occur in rare cases which may include cerebral involvement due to skull fracture. The present case report aims to describe the medical care, clinical evolution, and impacts of lesions of a case of dog bite in a University Hospital. A 2-month-old female infant was in the baby-safe sleeper under supervision of the caregiver when she was attacked by a family dog. The infant showed uncontrollable vomiting, decreased level of consciousness, hypoactivity, fixed and pinpoint pupils, and hypovolemic shock. Owing to the severity of the fracture with scalping of the right temporal bone with exposed fracture and active bleeding, high-resolution computed tomography of the cranial region was indicated. The infant was referred to the surgical center to perform exploratory craniotomy. Plastic surgery was performed to allow debridement of devitalized tissues, revision of hemostasis and suture of scalp in a single continuous plane, and cartilage in the right ear. Owing to the severity of the lesions, the wounds evolved with mouth corner deviation to the left, and the infant had eyelid myoclonia and clonic seizures in the right upper limb. The patient remained in the ICU for 12 days with seizures controlled by anticonvulsants and received antibiotic therapy. The infant attended the outpatient clinic for follow-up treatment in these areas: pediatric neurology, neurosurgery, plastic surgery, and motor physical therapy and visual rehabilitation. Nevertheless, the infant showed sequelae including left hemiparesis, hypertonia, hyperreflexia, and structural epilepsy. In pediatrics, the evaluation of dog bite victims requires systematization of medical care and quick hemodynamic and ventilatory support to reduce and prevent more severe sequelae, such as the neurological impairment of the present case. In addition, public health policies should emphasize the risks associated with dog bite incidents, even in domestic environments and by familiar animals.