PDF(Pubmed)
Abstract：
Acquired immune deficiency syndrome (AIDS)-associated cholangiopathy is a biliary tract condition seen in AIDS patients who are severely immunosuppressed, contributing to significant mortality in this population, even in developed countries with access to highly active antiretroviral therapy (HAART). We discuss a thirty-six-year-old human immunodeficiency virus (HIV)-positive male, non-compliant with HAART therapy, who presented with a one-year history of weight loss, persistent fatigue, and chronic diarrhea, which had worsened significantly in the past few weeks. Routine laboratory studies on presentation indicated elevated liver enzymes and alkaline phosphatase, a CD4 count of 2 cells/mm3, and a high HIV RNA count of 8.8 million. Imaging via CT of the abdomen and pelvis and ultrasound of the abdomen both displayed thickening and edema in the gallbladder without evidence of gallstones, raising concerns of acalculous cholecystitis. The patient subsequently decompensated, requiring intravenous vasopressors to maintain hemodynamic stability, broad-spectrum antibiotics, and resumption of antiretroviral therapy. Biliary fluid drainage was performed, and Cryptosporidium and cytomegalovirus (CMV) were detected via polymerase chain reaction (PCR) testing. The diagnosis of AIDS cholangiopathy was established; however, the patient\'s diarrhea worsened upon the introduction of tube feeds. Despite ongoing antimicrobial treatment, the patient developed a fever of 101.4°F, became asystolic and subsequently passed away. This case highlights the diagnostic, management, and therapeutic challenges of AIDS cholangiopathy. Also, it underscores the importance of thorough investigation into even mild or intermittent diarrhea and abnormal liver function tests in all HIV-infected patients, particularly in severely immunosuppressed patients. AIDS cholangiopathy should be considered in AIDS patients with diarrhea and abnormal liver function tests, irrespective of age, due to its associated morbidity across all age groups. Laboratory investigations often reveal markedly elevated alkaline phosphatase, gamma-glutamyltransferase, and mild to moderate liver enzyme elevations as hallmark findings of AIDS cholangiopathy. Ultrasonography is the first-line screening modality of AIDS cholangiopathy. Cryptosporidium parvum is the most common infectious etiology of AIDS cholangiopathy and can be identified by DNA-based polymerase chain reaction (PCR) testing of the stool or biliary fluid or acid-fast staining of stool specimens. Early detection of HIV infection and the prompt initiation and adherence to highly active antiretroviral therapy (HAART), which helps with maintaining a normal CD4 count and a low HIV viral load through HAART therapy, thereby significantly reducing the risk of developing AIDS cholangiopathy in HIV patients.
摘要：
获得性免疫缺陷综合征（AIDS）相关的胆管疾病是在严重免疫抑制的AIDS患者中看到的胆道疾病。导致这一人群的显著死亡率，即使在获得高效抗逆转录病毒疗法（HAART）的发达国家也是如此。我们讨论了一名36岁的人类免疫缺陷病毒（HIV）阳性男性，不符合HAART治疗，他有一年的减肥史，持续性疲劳,慢性腹泻,在过去的几周里，情况明显恶化。常规实验室检查提示肝酶和碱性磷酸酶升高，CD4计数为2个细胞/mm3，HIVRNA计数为880万。通过腹部和骨盆的CT成像以及腹部的超声检查均显示胆囊增厚和水肿，而没有胆结石的证据。引起非结石性胆囊炎的关注。患者随后代偿失调，需要静脉内血管加压剂以维持血流动力学稳定，广谱抗生素,恢复抗逆转录病毒治疗。进行胆液引流,通过聚合酶链反应（PCR）检测隐孢子虫和巨细胞病毒（CMV）。诊断为艾滋病胆管病变;然而,患者的腹泻在引入管饲后恶化。尽管正在进行抗菌治疗，病人发烧101.4°F,出现了精神错乱，随后去世了。这个案例突出了诊断，管理,和艾滋病胆管病变的治疗挑战。此外，它强调了彻底调查所有艾滋病毒感染患者的轻度或间歇性腹泻和异常肝功能检查的重要性，特别是在严重免疫抑制患者中。在有腹泻和肝功能异常的艾滋病患者中，应考虑艾滋病胆管病变，不论年龄,由于其在所有年龄组的相关发病率。实验室检查通常显示碱性磷酸酶明显升高，γ-谷氨酰转移酶，轻度至中度肝酶升高是AIDS胆管病变的标志。超声检查是艾滋病胆管病变的一线筛查方式。微小隐孢子虫是AIDS胆管病最常见的感染性病因，可通过粪便或胆汁液的基于DNA的聚合酶链反应（PCR）检测或粪便标本的抗酸染色进行鉴定。早期发现艾滋病毒感染，并迅速开始和坚持高活性抗逆转录病毒治疗（HAART），这有助于通过HAART治疗维持正常的CD4计数和低的HIV病毒载量，从而显著降低HIV患者发生AIDS胆管病变的风险。
