Birner Barbara, Hirzel Cédric, Wagner Franca, Waldegg Gabriel
Internal Medicine, Regionalspital Emmental AG, Burgdorf, Switzerland.
Infectious Diseases, Inselspital Universitatsspital Bern, Bern, Switzerland.
BMJ Case Rep. 2018 Jan 4;2018:bcr-2017-221998. doi: 10.1136/bcr-2017-221998.
Posterior reversible encephalopathy syndrome (PRES) is a rare but well-described syndrome associated with a high morbidity and a substantial mortality. We present an illustrative case of an HIV-infected but virologically suppressed patient who complained of visual impairment accompanied by severe headache and epileptic seizures. The cerebral CT scan and the follow-up cranial MRI confirmed the diagnosis of PRES. Unlike the cases of HIV-infected patients with PRES published so far, our patient suffered neither from advanced immunodeficiency nor from opportunistic infection or from any other evident predisposing factor. This case highlights that the absence of classical risk factors does not exclude the diagnosis of PRES. We discuss the hypothesis that in accordance with the new pathophysiological theory, persistent HIV-associated cerebrovascular reactivity in combination with endothelial dysfunction may represent an undetected risk factor for the development of PRES in virologically and immunologically stable patients.
后部可逆性脑病综合征（PRES）是一种罕见但描述详尽的综合征，具有高发病率和相当高的死亡率。我们报告一例病例，患者为HIV感染者但病毒学得到抑制，主诉视力障碍并伴有严重头痛和癫痫发作。脑部CT扫描及后续头颅MRI证实了PRES的诊断。与迄今发表的HIV感染合并PRES的病例不同，我们的患者既没有晚期免疫缺陷，也没有机会性感染或任何其他明显的诱发因素。该病例强调，缺乏经典危险因素并不排除PRES的诊断。我们讨论了这样一种假说，即根据新的病理生理理论，持续的HIV相关脑血管反应性与内皮功能障碍相结合，可能是病毒学和免疫学稳定患者发生PRES的一个未被发现的危险因素。
