Ramírez-Amador Velia, Anaya-Saavedra Gabriela, González-Ramírez Imelda, Mosqueda-Gómez Juan Luis, Esquivel-Pedraza Lilly, Reyes-Gutiérrez Edgardo, Sierra-Madero Juan
Universidad Autónoma Metropolitana-Xochimilco.
Med Oral Patol Oral Cir Bucal. 2005 Mar-Apr;10(2):109-14.
The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a mycobacterial infection in the oral mucosa, probably tuberculosis (TB) was identified. The purpose is to describe the clinical and histological findings in an HIV-infected patient, who after being treated successfully for tuberculous lymphangitis 4 years ago, presented with a lingual ulcer as the only suggestive sign of recurrence of mycobacterial infection, probably M. tuberculosis. A 39-year-old man seen in the HIV clinic of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" in Mexico City since 1991 for HIV infection. In 1999 the patient developed tuberculous lymphangitis; he was managed with a 4-drug regimen for 12 months, with improvement of local and systemic symptoms. In May of 2003, the patient presented a painful superficial lingual ulcer, 0.7 cm in diameter, well circumscribed, crateriform with slightly elevated, irregular and indurated borders, of 4 months duration. The histopathological examination showed chronic granulomatous inflammation with giant multinucleated cells, suggestive of mycobacterial infection, and recurrence of TB was considered. Rifampin, isoniazide, pyrazinamide, ethambutol and streptomycin were administered. The lingual lesion improved with partial healing at the first week and total remission at 45 days after the beginning of the antituberculous treatment. In June, 2003, the patient began highly active antiretroviral therapy (HAART) that included two NRTIs and one NNRTI. At 7 months of follow-up, the patient remains free of lingual lesions. The particularity of the present case is that the lingual ulcer was the only sign of infection by mycobacteria, suggestive of TB, in an HIV/AIDS patient that probably represented a recurrence of a previous episode.
该报告描述了一名在墨西哥城一家转诊中心就诊的艾滋病毒/艾滋病患者，在其口腔黏膜中发现了一种分枝杆菌感染，可能是结核病（TB）。目的是描述一名艾滋病毒感染患者的临床和组织学表现，该患者4年前成功治疗结核性淋巴管炎后，出现舌部溃疡，这是分枝杆菌感染（可能是结核分枝杆菌）复发的唯一提示性体征。一名39岁男性，自1991年起在墨西哥城国家医学与营养科学研究所“萨尔瓦多·苏比拉án”的艾滋病毒诊所接受艾滋病毒感染治疗。1999年该患者患上结核性淋巴管炎；采用四联药物疗法治疗12个月，局部和全身症状有所改善。2003年5月，患者出现一个直径0.7厘米的浅表性舌部溃疡，边界清晰，呈火山口状，边缘稍隆起、不规则且硬结，病程4个月。组织病理学检查显示为慢性肉芽肿性炎症，伴有巨大多核细胞，提示分枝杆菌感染，考虑为结核病复发。给予利福平、异烟肼、吡嗪酰胺、乙胺丁醇和链霉素治疗。舌部病变在抗结核治疗开始后第一周部分愈合，45天时完全缓解。2003年6月，患者开始接受高效抗逆转录病毒治疗（HAART），包括两种核苷类逆转录酶抑制剂和一种非核苷类逆转录酶抑制剂。在7个月的随访中，患者舌部病变未再出现。本病例的特殊之处在于，舌部溃疡是一名艾滋病毒/艾滋病患者中分枝杆菌感染（提示结核病）的唯一体征，可能代表先前发作的复发。
