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中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 350 -355. doi: 10.3877/cma.j.issn.1674-1358.2021.05.010

病例报告

获得性免疫缺陷综合征合并神经梅毒及巨细胞病毒脑炎一例并相关文献分析
周莹莹1, 邓莉平2, 鲁植艳3, 苏志颖1, 熊勇1,()   
  1. 1. 324000 衢州市,温州医科大学附属衢州医院呼吸与危重医学科
    2. 430071 武汉市,武汉大学中南医院感染科
    3. 430071 武汉市,武汉大学中南医院影像科
  • 收稿日期:2020-11-27 出版日期:2021-10-15
  • 通信作者: 熊勇
  • 基金资助:
    "十三五"艾滋病和病毒性肝炎等重大传染病防治科技重大专项(No. 2017ZX10202101-001)

A case of acquired immune deficiency syndrome combined with neurosyphilis and cytomegalovirus encephalitis and related literature review

Yingying Zhou1, Liping Deng2, Zhiyan Lu3, Zhiyin Su1, Yong Xiong1,()   

  1. 1. Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
    3. Department of Imaging, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
  • Received:2020-11-27 Published:2021-10-15
  • Corresponding author: Yong Xiong
引用本文:

周莹莹, 邓莉平, 鲁植艳, 苏志颖, 熊勇. 获得性免疫缺陷综合征合并神经梅毒及巨细胞病毒脑炎一例并相关文献分析[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(05): 350-355.

Yingying Zhou, Liping Deng, Zhiyan Lu, Zhiyin Su, Yong Xiong. A case of acquired immune deficiency syndrome combined with neurosyphilis and cytomegalovirus encephalitis and related literature review[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(05): 350-355.

目的

提升对获得性免疫缺陷综合征(AIDS)合并神经梅毒及巨细胞病毒脑炎的认识。

方法

分析1例AIDS合并神经梅毒及巨细胞病毒脑炎患者的诊疗经过,并结合相关文献进行复习。

结果

1例CD4+ T细胞为65个/μl的21岁AIDS男性患者,因发热和构音障碍于2019年6月14日至武汉大学中南医院住院诊治,完善相关检查后确诊为梅毒螺旋体及巨细胞病毒混合颅内感染,脑部磁共振成像(MRI)提示颅内多发异常信号。经驱梅、抗巨细胞病毒并及时启动高效抗反转录病毒治疗(HAART)等综合治疗后症状明显缓解,颅内多发异常信号较前吸收,预后较好。

结论

AIDS合并神经梅毒和巨细胞病毒脑炎应及时诊断,给予驱梅、抗巨细胞病毒等综合治疗并适时启动HAART,可改善患者预后。

Objective

To enhance the awareness on acquired immune deficiency syndrome (AIDS) combined with neurosyphilis and cytomegalovirus encephalitis.

Method

The process of diagnosis and treatment of one AIDS patient combined with neurosyphilis and cytomegalovirus encephalitis were analyzed, and the related literature were reviewed.

Results

On June 14th, 2019, a 21-year-old male AIDS patient with CD4+ T as 65 cells/μl was admitted to Zhongnan Hospital of Wuhan University due to fever and dysarthria. The case was diagnosed as mixed infection of treponema pallidum and cytomegalovirus after complete examination. The magnetic resonance imaging (MRI) of brain showed multiple abnormal intracranial signals. The condition of the patient was relieved and multiple abnormal intracranial signals were absorbed and the prognosis was relatively well after anti-treponema pallidum, anti-cytomegalovirus and initiation of highly active antiretroviral therapy (HAART) at the right moment.

Conclusions

For patients with AIDS combined with neurosyphilis and cytomegalovirus encephalitis, timely diagnosis, combined treatment with anti-treponema pallidum and anti-cytomegalovirus and initiation of HAART at the right moment could improve the prognosis.

图1 2019年6月17日患者脑MRI平扫注:脑桥-丘脑-下丘脑及双侧脑室、第四脑室周围见片状长T2信号
图2 2019年7月10日患者脑MRI平扫注:右侧颞叶、脑干、左侧丘脑、双侧尾状核头多发长T2信号,脑干、左侧丘脑、第四脑室旁较前片(2019年6月17日)病灶范围缩小、吸收好转
图3 2019年9月10日患者脑MRI平扫注:左侧基底节区、脑干、左侧丘脑、第四脑室旁多发长T2信号,对比前片(2019年7月10日)左侧基底节区新增病灶,脑干、左侧丘脑、第四脑室旁高信号灶范围缩小
图4 2019年10月22日患者脑MRI平扫注:左侧基底节区、脑干、左侧丘脑、右侧小脑半球多发长T2信号,对比前片(2019年9月10日),左侧基底节区病灶范围缩小,右侧小脑半球新增病灶
图5 2020年8月5日患者脑MRI平扫注:左侧基底节区、脑干、左侧丘脑、右侧小脑半球多发长T2信号(左侧基底节区和右侧小脑半球病灶较前2019年10月22日缩小)
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