Yoganathan Katie Tharshana, Cherif Soumeya, Rashid Mariam, Yoganathan Kathir
University College London, London, UK.
Department of HIV/GUM, Singleton Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK.
SAGE Open Med Case Rep. 2017 Aug 18;5:2050313X17722648. doi: 10.1177/2050313X17722648. eCollection 2017.
We report a case of acute recurrent meningitis in an HIV-positive immunocompetent woman. In this case, a 34-year-old African woman with a known HIV infection presented with symptoms of acute meningitis. She was on combination antiretroviral therapy with abacavir, lamivudine, and nevirapine. Her HIV RNA level was <70 IU/mL, and CD4 counts were 640 cells/mm. This indicates that she was not immunocompromised. She was febrile on examination, with marked neck stiffness. Her cerebrospinal fluid revealed raised white cell counts with 100% lymphocytes and mildly raised protein. Polymerase chain reaction confirmed herpes simplex type 2 meningitis. She recovered fully with aciclovir 800 mg three times a day. However, she was readmitted with a similar presentation 5 months after the initial admission. Her cerebrospinal fluid confirmed recurrent herpes simplex type 2 meningitis. This case alerts the profession to the possibility of non-opportunistic infections in an immunocompetent HIV-positive patient and of herpes simplex virus type 2 causing recurrent lymphocytic meningitis.
我们报告了一例HIV阳性免疫功能正常女性的急性复发性脑膜炎病例。在此病例中，一名34岁已知感染HIV的非洲女性出现急性脑膜炎症状。她正在接受阿巴卡韦、拉米夫定和奈韦拉平的联合抗逆转录病毒治疗。她的HIV RNA水平<70 IU/mL，CD4细胞计数为640个/mm。这表明她没有免疫功能低下。检查时她发热，颈部明显僵硬。她的脑脊液显示白细胞计数升高，淋巴细胞占100%，蛋白质轻度升高。聚合酶链反应确诊为2型单纯疱疹病毒性脑膜炎。她通过每天三次服用800毫克阿昔洛韦完全康复。然而，在首次入院5个月后，她因类似症状再次入院。她的脑脊液确诊为复发性2型单纯疱疹病毒性脑膜炎。该病例提醒业内人士，免疫功能正常的HIV阳性患者可能发生非机会性感染，以及2型单纯疱疹病毒可导致复发性淋巴细胞性脑膜炎。
