Beekman Rachel, Hu Jessica M, Aronin Steven I, Malinis Maricar F
Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Neurohospitalist. 2018 Apr;8(2):86-91. doi: 10.1177/1941874417725969. Epub 2017 Oct 2.
We report a case of a Puerto Rican male with advanced AIDS who presented with multiple falls and pancytopenia. Magnetic resonance imaging (MRI) of the brain, as initial workup, revealed 2 ring-enhancing brain lesions. Initial cerebrospinal fluid analysis revealed minimal cells, mildly elevated protein, and no organism seen on gram stain. Due to prohibitive thrombocytopenia, brain biopsy was deferred. He had neither clinical nor radiographic improvement despite empiric therapy for both toxoplasmosis and bacterial abscesses. Indicated by pancytopenia, bone marrow (BM) aspiration was performed. Culture of BM aspirate grew . Urine histoplasma antigen was markedly elevated. He was treated with liposomal amphotericin B (LamB) for progressive disseminated histoplasmosis with probable central nervous system involvement. Cerebrospinal fluid histoplasma antigen obtained after 2 months of LamB was detected. After prolonged course of LamB, he took itraconazole. Brain MRI at 7-month follow-up revealed significant improvement from baseline study.
我们报告一例患有晚期艾滋病的波多黎各男性病例，该患者出现多次跌倒和全血细胞减少。作为初步检查，脑部磁共振成像（MRI）显示有2个环形强化脑病变。初步脑脊液分析显示细胞数量极少、蛋白轻度升高，革兰氏染色未发现病原体。由于血小板减少严重，脑活检被推迟。尽管对弓形虫病和细菌性脓肿进行了经验性治疗，但他在临床和影像学上均无改善。鉴于全血细胞减少，进行了骨髓穿刺。骨髓穿刺培养生长出……尿组织胞浆菌抗原明显升高。他接受了脂质体两性霉素B（LamB）治疗，用于治疗可能累及中枢神经系统的播散性组织胞浆菌病。在使用LamB 2个月后检测到脑脊液组织胞浆菌抗原。经过长时间的LamB治疗疗程后，他服用了伊曲康唑。7个月随访时的脑部MRI显示与基线研究相比有显著改善。
