Maweni Robert, Kallampallil Jins, Leong Szewai, Akunuri Srikanth
Acute Medical Unit, Croydon University Hospital, London, UK.
Acute Medicine, National University Hospital, Singapore, Singapore.
BMJ Case Rep. 2017 Nov 21;2017:bcr-2017-222333. doi: 10.1136/bcr-2017-222333.
We describe the case of a 50-year-old woman presenting to our acute medicine department with generalised non-specific symptoms on a background of HIV managed on triple therapy (tenofovir, lamivudine and zidovudine). On admission, she was noted to be acidotic with proteinuria, glycosuria, hypophosphataemia and generalised body pain, and was diagnosed with Fanconi's renotubular syndrome secondary to tenofovir. It was also noted that she had elevated liver dysfunction markers, and an MRI of the liver revealed a focal stricture near the ampulla of Vater, resulting in a diagnosis of AIDS cholangiopathy. These two diagnoses are rare complications of HIV, and the presence of both these pathologies in a single patient has never been reported in the literature before, and we therefore believe that this case is the first of its kind.
我们描述了一名50岁女性的病例，她因出现全身性非特异性症状就诊于我们的急症医学科，其背景是正在接受三联疗法（替诺福韦、拉米夫定和齐多夫定）治疗的HIV感染。入院时，发现她存在酸中毒，伴有蛋白尿、糖尿、低磷血症和全身性身体疼痛，诊断为替诺福韦继发的范科尼肾小管间质综合征。还注意到她的肝功能指标升高，肝脏MRI显示在 Vater壶腹附近有局灶性狭窄，诊断为艾滋病胆管病。这两种诊断都是HIV感染的罕见并发症，且文献中此前从未报道过同一患者同时存在这两种病症，因此我们认为此病例为首例。
