AIDS合并进行性多灶性白质脑病1例  

AIDS complicated with progressive multifocal leukoencephalopathy:a case report

作　　者：胡典贵 陈晓东 温世飞 朱大庆 张伦理[2] Hu Diangui;Chen Xiaodong;Wen Shifei;Zhu Daqing;Zhang Lunli(Department of Infectious Diseases,Ganzhou Fifth People's Hospital,Jiangxi Ganzhou 341000,China;Department of Infectious Diseases,The First Affiliated Hospital of Nanchang University,Jiangxi Nanchang 330006,China)

机构地区：[1]赣州市第五人民医院感染科,江西赣州341000 [2]南昌大学第一附属医院感染科,江西南昌330006

出　　处：《新发传染病电子杂志》2024年第6期64-67,共4页Electronic Journal of Emerging Infectious Diseases

摘　　要：AIDS患者因机体免疫力下降容易合并中枢神经系统感染,John Cunningham(JC)病毒感染可导致进行性多灶性白质脑病(progressive multifocal leukoencephalopathy,PML),该病尚无特异性治疗方法,在抗病毒治疗(highly active antiretroviral therapy,HARRT)问世之前,病死率极高。本文报道1例青年男性患者,以单侧肢体麻木症状起病,后肢体麻木进行性加重,初筛HIV抗体阳性而入院。既往体健,无基础疾病。入院后查CD4+T淋巴细胞计数30个/μl,血HIV RNA 6.64×10^(4)copies/ml,脑脊液HIV RNA 5.16×10^(3)copies/ml,脑脊液宏基因组学二代测序检出JC病毒,结合患者头颅MRI表现,临床诊断AIDS合并PML,给予早期启动HARRT,患者肢体功能逐渐恢复,回归正常生活。本文通过此病例探讨AIDS合并PML的临床特点,影像学表现,以及抗病毒治疗方案,旨在提高临床医师的警惕性,当AIDS患者出现神经功能障碍,需明确是否合并PML,早期启动HARRT,改善患者预后。AIDS patients are prone to central nervous system infection due to decreased immunity,and JC virus infection can lead to progressive multifocal leukoencephalopathy(PML).There is no specific treatment for this disease,and before the advent of antiviral therapy(HARRT),the case fatality rate was extremely high.This article reports a young male patient who developed symptoms of unilateral limb numbness and progressively worsened numbness in the hind limbs.He was initially screened positive for HIV antibodies and admitted to the hospital.Previously healthy with no underlying diseases.After admission,CD4+T lymphocytescount was 30 cells/μl,6.64×10^(4) copies/ml of HIV RNA in blood,5.16×10^(3) copies/ml of HIV RNA in cerebrospinal fluid,and JC virus was detected by metagenomic second-generation sequencing(mNGS)in cerebrospinal fluid.Combined with the MRI findings of the patient's head,PML caused by AIDS was clinically diagnosed.After early initiation of HARRT,the patient's limb function gradually recovered and returned to normal life.Through this case,the clinical characteristics,imaging manifestations and antiviral treatment plan of AIDS combined with PML are discussed in this paper,aiming to improve the vigilance of clinicians.When HIV patients have neurological dysfunction,it is necessary to determine whether PML is combined or not,and early initiation of HARRT can improve the prognosis of patients.

关 键 词：艾滋病 进行性多灶性白质脑病 宏基因组二代测序 抗病毒治疗 

分 类 号：R512.91[医药卫生—内科学]