以消化道症状为首发表现的获得性免疫缺陷综合征误诊一例  

Digestive tract symptom as initial manifestation in acquired immunodeficiency syndrome:a misdiagnosed case

作　　者：陈健鑫 张晓燕 舒建昌 朱永建 吕霞 

机构地区：[1]广州市红十字会医院暨南大学医学院附属广州红十字会医院消化内科,广州510220

出　　处：《新医学》2017年第11期817-820,共4页Journal of New Medicine

摘　　要：近年来在临床上遇到获得性免疫缺陷综合征(AIDS)患者的几率大大提高,但在疾病早期因HIV抗体阴性或缺乏特征性临床表现,临床极易漏诊、误诊。该文报道1例以反复腹痛、腹泻、发热为首要症状的中年患者,初期行结肠镜、小肠镜等检查后误诊为克罗恩病,经针对克罗恩病相关治疗后有一定疗效但不能完全治愈。第2次住院时患者合并新型隐球菌性脑膜脑炎,且存在白细胞下降等免疫系统受损表现,经耐心询问病史后患者承认曾有冶游史,行HIV抗体初筛实验及确诊实验后诊断为AIDS。该例提示在临床上遇到以消化道症状为主诉的患者,经常规胃镜等检查仍无法确诊时,应注意排除AIDS等疾病的可能。n recent years , the incidence of acquired immunodeficiency syndrome （AIDS） has beensignificantly increased in clinical practice. Nevertheless , it is likely to make a misdiagnosis or miss the diagno-sis of AIDS due to negative human immunodeficiency virus （ HIV） antibody or lack of specific clinical manifes-tations during the early stage. In this article , we reported a middle-aged patient presenting with recurrent ab-dominal pain , diarrhea and fever as the primary symptoms. The patient was misdiagnosed with after receiving colonoscopy and enteroscopy examinations. The symptoms were partially mitigated after Crohn’s disease therapy , but the patient was not completely restored. During the 2nd hospitalization , the patient wascomplicated with cryptococcus neoformans meningoencephalitis , accompanied by leukopenia and other immune sytem impairment. After explicit inquiry of the medical history , the patient admitted sexual history- HIV body screening test was performed to make a definite diagnosis of AIDS. The diagnosis and treatment of thiscase hint that the possibility of AIDS and alternative diseases should be considered for plaints of gastrointestinal symptoms , which can not be diagnosed by routine gastroscopy.

关 键 词：获得性免疫缺陷综合征 人类免疫缺陷病毒 克罗恩病 新型隐球菌性脑膜脑炎 

分 类 号：R512.91[医药卫生—内科学]