Pohlen Michael Stephen, Sunwei Lin Jonathan, Wang Kevin Yuqi, Ghasemi-Rad Mohammad, Lincoln Christie M
Medical student, Baylor College of Medicine, Houston, Texas, USA.
Department of Radiology, Baylor College of Medicine, Houston, Texas, USA.
BMJ Case Rep. 2017 Dec 2;2017:bcr-2017-221866. doi: 10.1136/bcr-2017-221866.
A 28-year-old man recently diagnosed with HIV (CD4 19 cells/mm, viral load 3.6 million copies/mL, not on highly active antiretroviral therapy on initial diagnosis at outside hospital), disseminated histoplasmosis, shingles and syphilis presented with paraplegia developing over 3 days. Spine MRI demonstrated a longitudinally extensive cord lesion extending from C3 to the tip of the conus. Brain MRI was consistent with meningoencephalitis. Cerebrospinal fluid findings were notable for positive varicella zoster virus (VZV) and cytomegalovirus (CMV) PCRs as well as a Venereal Disease Research Laboratory titre of 1:2. Patient was started on treatment for VZV and CMV meningoencephalitis, neurosyphilis and high-dose steroids for infectious myelitis. Repeat spine MRI demonstrated subacute intramedullary haemorrhage of the cervical cord. He was ultimately discharged to a skilled nursing facility for long-term intravenous antiviral therapy and rehabilitation. After 59 days in the hospital, his neurological exam remained grossly unchanged, with flaccid paraplegia and lack of sensation to fine touch in his lower extremities.
一名28岁男性，近期诊断为HIV（CD4细胞计数为19个/mm³，病毒载量为360万拷贝/mL，在外院初诊时未接受高效抗逆转录病毒治疗），合并播散性组织胞浆菌病、带状疱疹和梅毒，在3天内出现截瘫。脊柱MRI显示脊髓病变纵向广泛，从C3延伸至圆锥尖端。脑部MRI与脑膜脑炎相符。脑脊液检查结果显示水痘带状疱疹病毒（VZV）和巨细胞病毒（CMV）PCR呈阳性，梅毒血清学试验滴度为1:2。患者开始接受VZV和CMV脑膜脑炎、神经梅毒治疗以及大剂量类固醇治疗感染性脊髓炎。复查脊柱MRI显示颈髓亚急性髓内出血。他最终被转至专业护理机构接受长期静脉抗病毒治疗和康复治疗。住院59天后，其神经学检查结果基本未变，仍为弛缓性截瘫，下肢对精细触觉无感觉。
