Swe Thein, Laurent Bordes P, Shah Nickul N
Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, USA.
Department of Neurology, Interfaith Medical Center, Brooklyn, New York, USA.
J Family Med Prim Care. 2016 Jul-Sep;5(3):685-687. doi: 10.4103/2249-4863.197304.
To our knowledge and literature search, concurrent cryptococcal meningitis and neurosyphilis in a patient have rarely been reported. Here, we report a 37-year-old male with HIV infection presented with headache and dizziness for 5 days along with memory difficulty and personality changes for about 1 week. During the hospital stay, cryptococcal meningitis was confirmed with positive cerebral spinal fluid (CSF) cryptococcal antigen titer (1:320) and positive CSF culture. Diagnosis of neurosyphilis was made based upon CSF white blood cell count of 85 cells/μL, with CSF total protein of 87 mg/dL, reactive CSF treponemal antibody, and fluorescent treponemal antibody. The patient was treated with amphotericin B, flucytosine, fluconazole, and benzathine penicillin G, and the patient was recovered and discharged. HIV patients are at high risk of developing severe infections of the central nervous system. Awareness should be made not only to single infection but also for dual pathology for a better and life-saving management.
据我们所知及文献检索，患者同时患有隐球菌性脑膜炎和神经梅毒的情况鲜有报道。在此，我们报告一名37岁的HIV感染男性，出现头痛和头晕5天，伴有记忆力减退和性格改变约1周。住院期间，脑脊液（CSF）隐球菌抗原滴度呈阳性（1:320）且脑脊液培养阳性，确诊为隐球菌性脑膜炎。根据脑脊液白细胞计数为85个/μL、脑脊液总蛋白为87mg/dL、脑脊液梅毒螺旋体抗体反应阳性以及荧光梅毒螺旋体抗体，诊断为神经梅毒。该患者接受了两性霉素B、氟胞嘧啶、氟康唑和苄星青霉素G治疗，随后康复出院。HIV患者发生严重中枢神经系统感染的风险很高。不仅要关注单一感染，还要注意双重病变，以便进行更好的挽救生命的治疗。
