Fica Alberto, Salinas Marcia, Jercic María Isabel, Dabanch Jeannette, Soto Andrés, Quintanilla Sergio, Flores Carlos
Servicio de Infectología, Hospital Militar, Santiago, Chile.
Servicio de Imagenología, Hospital Militar, Santiago, Chile.
Rev Chilena Infectol. 2017 Feb;34(1):69-76. doi: 10.4067/S0716-10182017000100011.
Although infrequent, Trypanosoma cruzi reactivation is possible among patients with HIV/AIDS infection that develop a tumor-like or granulomatous lesion in the CNS. We report the case of a 60 years old male patient with HIV/AIDS and low CD4 lymphocytes count with cerebellar symptoms and mild paresis, associated to supra and infratentorial hypodense lesions and positive serology tests both to T. gondii and Trypanosoma cruzi. Empirical therapy against toxoplasmosis was prescribed together with antiretroviral therapy but without a favorable response. Brain Chagas disease was confirmed by quantitative PCR in the CSF but he died despite nifurtimox treatment. Despite its rare occurrence, Chagas disease affecting the CNS is possible among patients with HIV/AIDS infection. Epidemiological exposure, a positive Chagas serological test and the image pattern of brain lesions support the suspicion. Diagnosis can be confirmed by molecular test in CSF samples, including new quantitative methods. Despite an adverse prognosis, specific therapy can be attempted besides antiretroviral treatment.
虽然不常见，但在中枢神经系统出现肿瘤样或肉芽肿性病变的HIV/AIDS感染患者中，克氏锥虫再激活是有可能的。我们报告了一例60岁男性HIV/AIDS患者，其CD4淋巴细胞计数低，有小脑症状和轻度轻瘫，伴有幕上和幕下低密度病变，弓形虫和克氏锥虫血清学检测均为阳性。针对弓形虫病的经验性治疗与抗逆转录病毒治疗同时进行，但未见良好疗效。脑脊液定量PCR确诊为脑型恰加斯病，尽管使用了硝呋莫司治疗，患者仍死亡。尽管恰加斯病影响中枢神经系统的情况罕见，但在HIV/AIDS感染患者中仍有可能发生。流行病学暴露、恰加斯血清学检测阳性以及脑病变的影像学表现支持这一怀疑。通过脑脊液样本的分子检测，包括新的定量方法，可以确诊。尽管预后不良，但除抗逆转录病毒治疗外，仍可尝试进行特异性治疗。
