不典型 HIV 空泡性脊髓病：一例报告。
Atypical HIV-vacuolar myelopathy: a case report.
机构信息
Department of Internal Medicine, Nelson Mandela Academic Central Hospital (NMACH), Walter Sisulu University, Mthatha, South Africa.
Division of Neurology, NMACH, Walter Sisulu University, Mthatha, South Africa.
出版信息
Eur J Med Res. 2021 Feb 1;26(1):13. doi: 10.1186/s40001-021-00483-0.
BACKGROUND
Here, we report an atypical HIV-vacuolar myelopathy and search the available medical literature about atypical presentations of human immunodeficiency virus associate vacuolar myelopathy (HIV-VM) and immunoglobulin therapy response.
CASE
A 26-year-old lady who was 4 weeks postpartum presented to us with acute flaccid quadriparesis, with no sensory level. Extensive workup ruled out other causes of myelopathy. She developed a stage 3 acute kidney injury, and MRI showed diffuse cord atrophy involving the lower cervical and thoracic cord. The patient received IV-immunoglobulin, ARVs, and supportive therapy with inadequate response. Unfortunately, she developed nosocomial pneumonia and died.
DISCUSSION
In HIV-VM, there is spinal cord atrophy, which mainly involves the thoracic cord. In our case, this pathological process also affected the spinal cord's cervical region, leading to flaccid tetraplegia, with high CD4 level, without response to the treatment, including intravenous immunoglobulin.
KEYNOTES
Vacuolar myelopathy, HIV, Immunoglobulin therapy, flaccid tetraplegia, hypokalaemia. Renal failure.
背景
本研究报告了一例不典型的 HIV 空泡性脊髓病，并检索了有关人类免疫缺陷病毒相关空泡性脊髓病（HIV-VM）和免疫球蛋白治疗反应的不典型表现的现有医学文献。
病例
一位 26 岁的女性，产后 4 周，出现急性弛缓性四肢瘫痪，无感觉平面。广泛的检查排除了其他脊髓病的原因。她发生了 3 期急性肾损伤，MRI 显示弥漫性脊髓萎缩，累及颈下部和胸段脊髓。患者接受了 IV 免疫球蛋白、ARV 和支持治疗，但反应不佳。不幸的是，她发生了医院获得性肺炎并死亡。
讨论
在 HIV-VM 中，脊髓萎缩主要累及胸段。在我们的病例中，这个病理过程还影响了脊髓的颈部区域，导致弛缓性四肢瘫痪，伴有高 CD4 水平，对包括静脉注射免疫球蛋白在内的治疗没有反应。
关键点
空泡性脊髓病、HIV、免疫球蛋白治疗、弛缓性四肢瘫痪、低钾血症、肾衰竭。
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