Good综合征继发中枢神经系统复杂感染一例报告并文献复习  

Central nervous system complex infection caused by Good syndrome:a case report and literature review

作　　者：李言洵 刘华旭 王倩 周翠萍 陈黔妹 汪慧 刘芳[1] LI Yanxun;LIU Huaxu;WANG Qian;ZHOU Cuiping;CHEN Qianmei;WANG Hui;LIU Fang(Department of Neurology,the First Hospiatl of Tisnghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院神经内科,北京100016

出　　处：《中国研究型医院》2022年第6期56-59,共4页Chinese Research Hospitals

摘　　要：患者女,51岁,因低热3个半月,肢体麻木、无力2个月入院。影像检查提示中枢神经系统多发病灶;脑脊液宏基因组二代测序(mNGS)提示巨细胞病毒感染;痰液及肺泡灌洗液检查提示结核分枝杆菌、耶氏肺孢子菌、肺炎链球菌等多重感染;纵隔占位活检组织病理检查,初步诊断A型胸腺瘤;行淋巴细胞亚群检查提示血清免疫球蛋白IgG及IgM减少,总B淋巴细胞、辅助性T细胞、抑制性T细胞以及CD4^(+)/CD8^(+)比值均显著下降,确诊为Good综合征(GS)。该患者经静脉滴注人免疫球蛋白治疗后,肢体无力症状平稳好转,肺部感染得到控制出院。One 51-year-old female patient was admitted to the hospital with a low-grade fever for 3.5 months and limb numbness and weakness for 2 months.Imaging showed multiple lesions in the central nervous system.The macrogenomic second-generation sequencing(mNGS)of cerebrospinal fluid indicated cytomegalovirus infection.The sputum and bronchoalveolar lavage fluid showed multiple infections of Mycobacterium tuberculosis,Pneumocystis jasinii and Streptococcus pneumoniae.A histopathological examination of mediastinal space biopsy was performed,and a preliminary diagnosis of type A thymoma was made;lymphocyte subpopulation examination revealed a serum immunoglobulin IgG and IgM decreased,B lymphocytes,helper T cell,suppressor T cell and CD4^(+)/CD8^(+)ratio decreased significantly,which was diagnosed as Good syndrome(GS).After treatment with intravenous immunoglobulin,the patient was discharged with smooth improvement of limb weakness and control of pulmonary infection.

关 键 词：伴胸腺瘤的免疫缺陷症 低丙种球蛋白血症 巨细胞病毒 结核 中枢神经系统感染 

分 类 号：R742.9[医药卫生—神经病学与精神病学] R593[医药卫生—临床医学]