Shintaku M, Sasaki M, Senzaki H, Morii S, Maruoka M, Ueda Y
Department of Pathology, Osaka Red Cross Hospital, Japan.
Acta Pathol Jpn. 1991 Dec;41(12):895-9. doi: 10.1111/j.1440-1827.1991.tb01635.x.
The patient was a 46-year-old male hemophiliac who died of acute mycobacterial meningitis associated with AIDS (acquired immune deficiency syndrome). Autopsy revealed severe basal meningitis which was characterized by an infiltration of numerous polymorphonuclear leukocytes. Severe mural inflammation of the subarachnoid arteries was noted, and innumerable acid-fast bacilli were demonstrated. Epithelioid cell granulomas were not found in the meningeal lesion. The lungs, liver, spleen, and bone marrow contained many epithelioid cell granulomas with caseous necrosis. Massive proliferation of swollen histiocytes could not be identified in any organ. The absence of epithelioid cell granulomas in the meningeal lesion indicate a severe impairment of cell-mediated immunity in the patient; this anergic type of lesion is one of the characteristics of tuberculosis occurring in association with terminal AIDS.
该患者为一名46岁的男性血友病患者，死于与艾滋病（获得性免疫缺陷综合征）相关的急性分枝杆菌性脑膜炎。尸检显示严重的基底脑膜炎，其特征为大量多形核白细胞浸润。蛛网膜下动脉出现严重的壁层炎症，可见无数抗酸杆菌。脑膜病变中未发现上皮样细胞肉芽肿。肺、肝、脾和骨髓中有许多伴有干酪样坏死的上皮样细胞肉芽肿。任何器官均未发现肿胀组织细胞的大量增殖。脑膜病变中缺乏上皮样细胞肉芽肿表明患者细胞介导的免疫严重受损；这种无反应型病变是晚期艾滋病相关结核病的特征之一。
