1例以急性化脓性扁桃体炎为首发表现的急性HIV感染患者的诊治分析  

Diagnosis and treatment analysis of one patient with acute human immunodeficiency virus infection presented with acute suppurative tonsillitis as the initial manifestation

作　　者：冯理智 何浩岚 陈志敏 刘波[1] 刘新华[1] 赵涵[1] Feng Lizhi;He Haolan;Chen Zhimin;Liu Bo;Liu Xinhua;Zhao Han(Infection Disease Center,Guangzhou Eighth People’s Hospital Guangzhou Medical University,Guangzhou,Guangdong 510440,China)

机构地区：[1]广州医科大学附属市八医院感染病中心,广东广州510440

出　　处：《感染、炎症、修复》2025年第2期124-126,共3页Infection Inflammation Repair

基　　金：广州市卫生健康科技项目(20231A010028)。

摘　　要：目的:报告1例以急性化脓性扁桃体炎为首发表现的急性人类免疫缺陷病毒(HIV)感染患者的诊治过程,以提高临床对该疾病的认识。方法:2023年6月5日收治1例以急性化脓性扁桃体炎为首发表现的急性HIV感染患者,患者为中年男性,因咽痛7 d、加重伴发热2 d入院,总结患者的临床表现、诊断过程和治疗情况。结果:患者入院后首次HIV初筛试验结果为阴性,给予抗感染治疗后咽痛等症状缓解,但实验室检查提示免疫功能显著异常:CD4^(+)T淋巴细胞计数降至147个/μL,CD8^(+)T淋巴细胞异常激活并升高,T辅助/抑制淋巴细胞比例倒置。鉴于免疫紊乱特征与HIV感染窗口期表现高度吻合,再次行HIV初筛试验,后续完善HIV确证试验(免疫印迹法)、病毒载量检测及流行病学调查,最终确诊为HIV急性感染。于2023年6月14日起使用比克恩丙诺进行抗病毒治疗,后病情稳定出院随访。结论:HIV感染急性期以急性化脓性扁桃体炎为首发表现者相对少见,诊断时应重视流行病史的追查,确诊后尽快启动抗HIV治疗,降低传播可能性。Objective:To report the diagnosis and treatment process of a patient with acute human immunodeficiency virus(HIV)infection presented with acute suppurative tonsillitis as the initial manifestation,in order to enhance the clinical understanding of this disease.Methods:On June 5,2023,a middle-aged male patient with acute HIV infection who presented with acute suppurative tonsillitis as the initial manifestation was admitted.The patient was admitted due to sore throat for one week,aggravated and accompanied by fever for two days.Summarize the clinical manifestations,diagnostic process and treatment of the patient.Results:The result of the patient's first HIV preliminary screening test after admission was negative.After anti-infective treatment,symptoms such as sore throat were relieved.However,laboratory tests indicated significant abnormalities in immune function:the count of CD4^(+)T lymphocytes decreased to 147 cells/μL,CD8^(+)T lymphocytes were abnormally activated and increased,and the ratio of T helper/suppressor lymphocytes was inverted.Given that the characteristics of immune disorders were highly consistent with the manifestations during the window period of HIV infection,the HIV primary screening test was conducted again.Subsequently,the HIV confirmation test(Western blotting),viral load detection and epidemiological investigation were completed.Eventually,it was diagnosed as acute HIV infection.On June 14,2023,the patient began antiviral treatment with Bictegravir Sodium,Emtricitabine and Tenofovir Alafenamide Fumarate Tablets.Later,the patient’s condition stabilized and was discharged for follow-up.Conclusions:Acute suppurative tonsillitis as the initial manifestation in the acute stage of HIV infection is relatively rare.During diagnosis,attention should be paid to the investigation of the epidemiological history.Anti-hiv treatment should be initiated as soon as possible after diagnosis to reduce the possibility of transmission.

关 键 词：急性化脓性扁桃体炎 人类免疫缺陷病毒 感染 获得性免疫缺陷综合征 

分 类 号：R512.91[医药卫生—内科学]