Vidal J E, Tuon F F
Department of Neurology, Emílio Ribas Institute of Infectious Diseases, São Paulo, Brazil.
Int J STD AIDS. 2009 Sep;20(9):654-6. doi: 10.1258/ijsa.2008.008437.
We report a case of viridans streptococcus brain abscess in a severely immunosuppressed HIV-infected patient with a history of chronic sinusitis. A 39-year-old homosexual man showed mental confusion and worsening of a frontal brain lesion after two weeks with antitoxoplasma therapy. Empiric treatment for central nervous system tuberculosis and pyogenic brain abscess was started. He underwent surgical drainage and the diagnosis of brain abscess due to viridans streptococci was confirmed. All empiric treatments were stopped and ceftriaxone was used for eight weeks, showing complete clinical and radiological resolution. Although infrequent, viridans streptococci, a common pyogenic aetiology of brain abscess in immunocompetent patients, should be considered in the differential diagnosis of brain lesions in AIDS patients.
我们报告了一例患有慢性鼻窦炎病史的严重免疫抑制的HIV感染患者发生草绿色链球菌脑脓肿的病例。一名39岁的同性恋男性在接受抗弓形虫治疗两周后出现精神错乱和额叶脑病变加重。开始对中枢神经系统结核和化脓性脑脓肿进行经验性治疗。他接受了手术引流，草绿色链球菌所致脑脓肿的诊断得以证实。所有经验性治疗均停止，使用头孢曲松治疗八周，临床和影像学表现完全消退。尽管罕见，但草绿色链球菌作为免疫功能正常患者脑脓肿常见的化脓性病因，在艾滋病患者脑病变的鉴别诊断中应予以考虑。
