Kim Su Bin, Shrivastava Makeardhwaj Sarvadaman, Strakhan Marianna
Department of Medicine, Albert Einstein College of Medicine , Jacobi Medical Center, Bronx, NY, USA.
Department of Hematology/Oncology, Albert Einstein College of Medicine , Jacobi Medical Center, Bronx, NY, USA.
Hematol Rep. 2015 Mar 9;7(1):5475. doi: 10.4081/hr.2015.5475. eCollection 2015 Feb 24.
A 21-year-old male with acquired immune deficiency syndrome, not on highly active antiretroviral treatment (HAART) was admitted after complaining of headache and intermittent diarrhea, found to have Cryptococcal meningitis. During the course of his hospitalization, patient developed pancytopenia. Anemia panel, serologies including Epstein barr virus, cytomegalovirus, and parvovirus were negative. Patient then developed high grade fever with elevated liver enzymes. Blood cultures, urine cultures, stool cultures, and repeat cerebrospinal fluid cultures remained negative. Patient subsequently developed skin lesions which on biopsy showed Kaposi's sarcoma, and upon endoscopy, noted to have gastrointestinal Kaposi's sarcoma involvement. Human herpes virus 8 was positive. Bone marrow biopsy revealed hemophagocytic lymphohistiocytosis. Despite having a concern for patient developing immune reconstitution syndrome which may worsen his meningitis, HAART was initiated and patient's symptoms improved including resolution of fevers and hematological as well as liver abnormalities. Kaposi's sarcoma improved as well.
一名21岁患有获得性免疫缺陷综合征的男性，未接受高效抗逆转录病毒治疗（HAART），在主诉头痛和间歇性腹泻后入院，被诊断为新型隐球菌脑膜炎。在住院期间，患者出现全血细胞减少。贫血相关检查、包括爱泼斯坦 - 巴尔病毒、巨细胞病毒和细小病毒的血清学检查均为阴性。随后患者出现高热伴肝酶升高。血培养、尿培养、粪便培养及重复脑脊液培养均为阴性。患者随后出现皮肤病变，活检显示为卡波西肉瘤，内镜检查发现胃肠道也有卡波西肉瘤累及。人疱疹病毒8呈阳性。骨髓活检显示噬血细胞性淋巴组织细胞增生症。尽管担心患者可能发生免疫重建综合征从而加重其脑膜炎，但仍启动了HAART治疗，患者症状改善，包括发热消退以及血液学和肝脏异常情况得到缓解。卡波西肉瘤也有所改善。
