Pastorello Ricardo Garcia, Costa Anderson da Costa Lino, Sawamura Marcio Valente Yamada, Nicodemo Antonio Carlos, Duarte-Neto Amaro Nunes
University of São Paulo, Faculty of Medicine, Pathology Department. São Paulo, SP, Brasil.
University of São Paulo, Faculty of Medicine, Parasitary and Infectious Diseases Department. São Paulo, SP, Brasil.
Autops Case Rep. 2018 Mar 16;8(1):e2018012. doi: 10.4322/acr.2018.012. eCollection 2018 Jan-Mar.
Extracerebral toxoplasmosis, with pulmonary involvement and shock, is a rare form of toxoplasmosis in patients with advanced AIDS. It can mimic pneumocystosis, histoplasmosis, and disseminated tuberculosis, and should be considered in the differential diagnosis of causes of respiratory failure and fulminant disease in this group of individuals, especially in areas where the infection is highly prevalent and in those without proper use of antimicrobial prophylaxis. We report the case of a 46-year-old male patient who presented to the emergency department with uremia, requiring urgent dialysis. During the laboratorial investigation, the patient had confirmed HIV infection, with a low CD4+ peripheral T-cell count (74 cells/µL). During hospitalization, the patient presented drug-induced hepatitis due to trimethoprim/sulfamethoxazole in a prophylactic dose, requiring interruption of this medication. On the 55th day of hospitalization, the patient developed refractory shock and died. At the autopsy, disseminated toxoplasmosis with encephalitis and severe necrotizing pneumonia were diagnosed, with numerous tachyzoites in the areas of pulmonary necrosis.
脑外弓形虫病合并肺部受累及休克，是晚期艾滋病患者中一种罕见的弓形虫病形式。它可类似肺孢子菌病、组织胞浆菌病和播散性结核病，在对这组患者呼吸衰竭和暴发性疾病病因进行鉴别诊断时应予以考虑，尤其在感染高度流行的地区以及未正确使用抗菌预防措施的患者中。我们报告一例46岁男性患者，因尿毒症就诊于急诊科，需要紧急透析。实验室检查期间，该患者确诊感染HIV，外周血CD4+ T细胞计数低（74个细胞/µL）。住院期间，患者因预防性剂量的甲氧苄啶/磺胺甲恶唑出现药物性肝炎，需要停用该药物。住院第55天，患者出现难治性休克并死亡。尸检时，诊断为播散性弓形虫病合并脑炎和严重坏死性肺炎，在肺部坏死区域发现大量速殖子。
