Icahn School of Medicine at Mount Sinai, New York, NY, USA
Department of Medicine, Mount Sinai Morningside, Mount Sinai West, New York, NY, USA.
BMJ Case Rep. 2022 Aug 30;15(8):e249902. doi: 10.1136/bcr-2022-249902.
We report a case of man in his 40s with a medical history of post-traumatic stress disorder who presented to the emergency department with altered mental status, ataxia, headache and dizziness a few hours after snorting amphetamines and mushrooms. Twenty-four hours after presentation, while no longer abusing amphetamines or mushrooms, he remained ataxic and dizzy. A CT scan of the head showed periventricular hypodensities. MRI of the brain revealed extensive confluent T2 hyperintense signal throughout the cerebral white matter, brainstem and cerebellar white matter. Given these findings and persistent ataxia, lumbar puncture was performed, and cerebrospinal fluid (CSF) meningoencephalitis panel was positive for cytomegalovirus (CMV), prompting a diagnosis of CMV encephalitis. Since CMV almost always occurs in the setting of immunocompromise, the patient was screened for HIV and found to be positive with a CD4 count of 22. He was treated with ganciclovir 5 mg/kg/dose intravenously every 12 hours, with resolution of all symptoms.
我们报告了一例 40 多岁男性的病例，他有创伤后应激障碍的病史，在吸食安非他命和蘑菇后几小时出现精神状态改变、共济失调、头痛和头晕。就诊 24 小时后，尽管不再滥用安非他命或蘑菇，但他仍出现共济失调和头晕。头部 CT 扫描显示脑室周围密度降低。脑部 MRI 显示大脑白质、脑干和小脑白质广泛融合的 T2 高信号。鉴于这些发现和持续的共济失调，进行了腰椎穿刺，脑脊液（CSF）脑膜脑炎检测呈巨细胞病毒（CMV）阳性，提示诊断为 CMV 脑炎。由于 CMV 几乎总是在免疫功能低下的情况下发生，因此对患者进行了 HIV 筛查，发现 CD4 计数为 22，呈阳性。他接受了更昔洛韦 5mg/kg/剂量静脉注射，每 12 小时一次，所有症状均得到缓解。
