Makie Toshio, Yamamoto Yoshihiko, Uehira Tomoko, Shirasaka Takuma, Takeda Masashi
AIDS Medical Center, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
Intern Med. 2007;46(7):415-8. doi: 10.2169/internalmedicine.46.1739. Epub 2007 Apr 2.
This report examines simultaneous tuberculous and syphilitic meningitis in a patient with human immunodeficiency virus (HIV). The 41-year-old homosexual patient presented with meningitis and hydrocephalus. His CD4+ and CD8+ T-lymphocyte counts per microliter were 60 and 71, respectively. His clinical presentation was of a rapid-onset cerebral attack incompatible with tuberculous meningitis. Imaging indicated fatal bilateral cerebral infarction at the basal nuclei, and basal meningitis. We believe that syphilitic meningitis in HIV exacerbated the central nervous system (CNS) damage caused by tuberculosis and syphilis. The combination of three pathogens, Mycobacterium tuberculosis, Treponema pallidum, and HIV, has a great potential to cause serious CNS damage.
本报告研究了一名感染人类免疫缺陷病毒（HIV）患者的结核性和梅毒性脑膜炎同时发病情况。这位41岁的同性恋患者表现出脑膜炎和脑积水症状。他每微升血液中的CD4+和CD8+ T淋巴细胞计数分别为60和71。其临床表现为急性起病的脑部发作，与结核性脑膜炎不符。影像学检查显示基底核区致命性双侧脑梗死以及基底脑膜炎。我们认为，HIV感染患者的梅毒性脑膜炎加剧了由结核和梅毒导致的中枢神经系统（CNS）损害。结核分枝杆菌、梅毒螺旋体和HIV这三种病原体共同作用，极有可能造成严重的CNS损害。
