Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, BCM-MS280, Houston, TX, 77030, USA.
Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Infection. 2017 Oct;45(5):715-718. doi: 10.1007/s15010-017-1037-9. Epub 2017 Jun 21.
A 38-year-old man presented with headaches and generalized weakness. He was found to have AIDS; a ring-enhancing central nervous system lesion was found on brain imaging and he had elevated serum Toxoplasma gondii IgG levels. A diagnosis of presumptive toxoplasma encephalitis was made and he received antiretrovirals and antitoxoplasma therapy for 4 years. Intermittent headaches and evidence of disease progression on neuroimaging warranted further evaluation and cerebrospinal fluid analysis revealed amebic forms on hematoxylin and eosin staining and positive polymerase chain reaction testing for Acanthamoeba spp. He was placed on miltefosine, fluconazole, trimethoprim-sulfamethoxazole and flucytosine for 7 months. Five months after therapy discontinuation he remains asymptomatic and is taking only antiretroviral therapy.
This is the first report of a patient with AIDS and granulomatous amebic encephalitis who survived with medical therapy only.
一名 38 岁男性因头痛和全身乏力就诊。他被诊断为艾滋病；脑部影像学检查发现环形增强的中枢神经系统病变，血清弓形虫 IgG 水平升高。诊断为疑似弓形虫脑炎，他接受了抗逆转录病毒和抗弓形虫治疗 4 年。间歇性头痛和神经影像学上的疾病进展证据需要进一步评估，脑脊液分析显示在苏木精和伊红染色上有阿米巴样形态，聚合酶链反应检测棘阿米巴属呈阳性。他接受米替福新、氟康唑、复方磺胺甲噁唑和氟胞嘧啶治疗 7 个月。停药 5 个月后，他仍无症状，仅接受抗逆转录病毒治疗。
这是首例仅通过药物治疗存活的艾滋病合并肉芽肿性阿米巴脑炎患者的报告。
