Kano Yasuhiro, Kodaira Minori, Ushiki Atsuhito, Kosaka Makoto, Yamada Mitsunori, Shingu Kunihiko, Nishihara Hiroshi, Hanaoka Masayuki, Sekijima Yoshiki
Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan.
Undergraduate Course, Shinshu University School of Medicine, Japan.
Intern Med. 2017 Sep 15;56(18):2497-2501. doi: 10.2169/internalmedicine.8776-16. Epub 2017 Aug 21.
A 49-year-old man presented with gradually progressive aphasia one month after being diagnosed with acquired immunodeficiency syndrome (AIDS). Brain magnetic resonance imaging showed multiple brain lesions with punctate and linear enhancement. A polymerase chain reaction detected Epstein-Barr virus (EBV) in the patient's cerebrospinal fluid. A diagnosis of isolated central nervous system lymphomatoid granulomatosis (CNS-LYG) was made based on the brain biopsy findings. The complete remission of CNS-LYG was achieved by anti-retroviral therapy (ART) alone. In the present case, the development of AIDS-associated CNS-LYG was considered to have been initiated by the reactivation of EBV in the CNS under immunosuppressive conditions. The patient's condition improved with the reconstitution of the patient's immune system.
一名49岁男性在被诊断为获得性免疫缺陷综合征(艾滋病)一个月后出现逐渐进展的失语症。脑部磁共振成像显示多个脑病变,有斑点状和线状强化。聚合酶链反应在患者脑脊液中检测到爱泼斯坦-巴尔病毒(EBV)。根据脑活检结果诊断为孤立性中枢神经系统淋巴瘤样肉芽肿病(CNS-LYG)。仅通过抗逆转录病毒疗法(ART)就实现了CNS-LYG的完全缓解。在本病例中,艾滋病相关的CNS-LYG的发生被认为是在免疫抑制条件下中枢神经系统中EBV重新激活所致。随着患者免疫系统的重建,病情有所改善。