■巨细胞病毒(CMV)视网膜炎,脑和眼弓形虫病是获得性免疫缺陷综合征(AIDS)患者的常见感染。材料和方法:这是一例46岁的女性,以前患有卡波西肉瘤,在住院前两周被诊断出患有HIV感染。诊断时的血液测试显示CD4+计数为77细胞/μL,HIV-RNA为3.758.745拷贝/mL。开始使用比替拉韦/恩曲他滨/替诺福韦治疗,进行了病毒免疫学和微生物学研究。
■患者因左枕顶头痛和视力模糊而到我院就诊。进行了脑部CT和MRI,未显示局灶性病变或血管改变。梅毒血清学呈阴性,弓形虫血清学显示IgG阳性,IgM阴性,血清CMV-DNA为31.184IU/mL。眼底有视网膜出血,荧光素血管造影和计算机断层扫描记录了棉质渗出物,视网膜出血和玻璃体受累。由于怀疑CMV视网膜炎,开始使用伐更昔洛韦进行治疗。大约一个月后,患者报告视力模糊,因此再次入院。眼底显示黄斑附近有棉质病变。玻璃体分子检测弓形虫阳性,而脑脊液是阴性的;此外,使用造影剂对大脑进行了MRI检查,显示高信号改变的区域与弓形虫葡萄膜炎和神经弓形虫病的诊断相符。开始使用乙胺嘧啶和克林霉素治疗(患者报告对磺胺过敏)。通过执行过敏测试(斑贴试验)进行过敏咨询,结果为阴性;因此,克林霉素的给药被磺胺嘧啶代替。抗弓形虫治疗开始一个月后,有临床和放射学的改善.
■尽管PLWH的管理不断发展,在这种情况下,在晚期患者中发现了两种不同的机会性感染。特别是,可以强调两个方面。第一个是,在高度受损的免疫系统中,临床表现可能是欺骗性的,在同一患者中可以同时观察到一种以上的机会性感染。第二个方面是开始抗逆转录病毒治疗后,已记录了病毒免疫参数的快速改善,可能导致免疫重建炎症综合征(IRIS)。
UNASSIGNED: cytomegalovirus (CMV) retinitis, cerebral and ocular
toxoplasmosis are common infections in patients with acquired immunodeficiency syndrome (AIDS). Material and methods: this is a
case of a 46-year-old female with previous Kaposi\'s sarcoma, diagnosed with an HIV infection two weeks prior to hospitalization. Blood test at diagnosis showed a CD4+ count of 77 cell/μL and HIV-RNA 3.758.745 copies/mL. Therapy with bictegravir/emtricitabine/tenofovir alafenamide fumarate was started and clinical, viroimmunological and microbiological investigations were performed.
UNASSIGNED: the patient went to our hospital for the onset of left occipito-parietal headache and blurred vision. Brain CT and MRI were performed which did not show focal lesions or vascular alterations. Syphilis serology was negative, Toxoplasma gondii serology showed positive IgG and negative IgM, serum CMV-DNA was 31.184 IU/mL. Eye fundus evidenced intraretinal hemorrhages, fluorescein angiography and computed optical tomography documented cottony exudates, retinal hemorrhages and vitreous involvement. Therapy with valganciclovir was initiated for suspicion of CMV retinitis. About a month later, the patient reported blurred vision for which she was re-admitted. Ocular fundus showed a cottony lesion near the macula. Molecular test on vitreous body was positive for Toxoplasma gondii, while on cerebrospinal fluid it was negative; in addition, an MRI of the brain with contrast medium was performed which showed an area of altered hyperintense signal compatible with a diagnosis of Toxoplasma gondii uveitis and neurotoxoplasmosis. Therapy with pyrimethamine and clindamycin (allergy for sulfonamide reported by the patient) was started. Allergy counseling was performed with the execution of allergy tests (patch test) with negative result; therefore the administration of clindamycin was replaced with sulfadiazine. A month following the start of anti-toxoplasma therapy, there was a clinical and radiological improvement.
UNASSIGNED: despite progressive developments in the management of PLWH, in this
case two different kind of opportunistic infection are found in a late-presenter patient. In particular, two aspects can be highlighted. The first one is that, in the setting of an highly impaired immune system, clinical presentation can be deceptive and more than one opportunistic infection can be observed together in the same patient. The second aspect is that after starting antiretroviral therapy, a rapid improvement of viro-immunologic parameters has been documented, probably leading to an immune reconstitution inflammatory syndrome (IRIS).