Inciarte Alexy, de la Mora Lorena, Huaier-Arriazu Emilio, Torres Berta, Cañizares Silvia, Zamora Elizabeth, Laguno Montserrat, Gonzalez-Cordón Ana, Foncillas Alberto, Chivite Ivan, Calvo Júlia, Ambrosioni Juan, Martínez Esteban, Blanco Jose Luis, Miro J M, Martinez-Rebollar Maria, Mallolas Josep
HIV Unit, Infectious Diseases Service, Hospital Clínic of Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
Fundació de Recerca Clínic Barcelona-Institutd InvestigacionsBiomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
Infect Dis Ther. 2024 Apr;13(4):647-658. doi: 10.1007/s40121-024-00962-x. Epub 2024 Apr 3.
A broadened clinical spectrum of concomitant complications emerges among the escalating incidence of substance use, particularly within the 'chemsex' context. This case exemplifies the profound neurotoxic repercussions and neurological risk of chemsex in a young HIV-positive male and addresses the multifaceted challenges of such evolving paradigms in substance utilization.
After consuming cannabis, poppers, methamphetamine, and cocaine, a 28-year-old HIV-positive male exhibited significant neurological and cognitive impairment. The initial presentation included dysarthria and profound anterograde amnesia. Laboratory findings showed leukocytosis with a PCR of 3 mg/dl - elevated cerebrospinal fluid protein levels with no cells. Urine toxicology returned positive for cannabis and amphetamines. A brain CT scan revealed bilateral and symmetrical hippocampi and pale globes hypodensity, indicative of toxic-metabolic encephalopathy. MRI further identified lesions in the globus pallidus, cerebellum, and hippocampi. Following the detection of toxic encephalopathy, Initial neuropsychological was performed screening using the Montreal Cognitive Assessment (MoCA), which highlighted immediate memory deficits. An in-depth neuropsychological assessment conducted 3 weeks later included the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), the Rey Auditory Verbal Learning Test (RAVLT), and tests for visuospatial skills, motor functions, and memory recall. The evaluations revealed pronounced anterograde amnesia, persistent long-term memory inconsistencies, and notable executive function challenges, detailed in Table 1.
The detailed analysis of this case underpins the severe neurological consequences that can manifest from heavy substance use. Comprehensive diagnostic evaluations, including neuroimaging and neuropsychological assessments, are crucial in elucidating the full spectrum of substance-induced cognitive impairments. There is an urgent need for enhanced public awareness and preventative measures, especially in the context of chemsex, to bring forth multifaceted health, social, and government implications that modern society must adeptly navigate.
随着物质使用发生率的不断上升，尤其是在“化学性爱”背景下，随之出现了范围更广的伴随并发症临床谱。本病例例证了化学性爱对一名年轻的HIV阳性男性造成的严重神经毒性影响和神经学风险，并探讨了物质使用中这种不断演变的模式所带来的多方面挑战。
一名28岁的HIV阳性男性在吸食大麻、Poppers药水、甲基苯丙胺和可卡因后，出现了严重的神经和认知障碍。最初的症状包括构音障碍和严重的顺行性遗忘。实验室检查结果显示白细胞增多，PCR为3毫克/分升，脑脊液蛋白水平升高但无细胞。尿液毒理学检测显示大麻和苯丙胺呈阳性。脑部CT扫描显示双侧对称的海马体和苍白球低密度影，提示中毒代谢性脑病。MRI进一步发现苍白球、小脑和海马体有病变。在检测到中毒性脑病后，最初使用蒙特利尔认知评估量表（MoCA）进行了神经心理学筛查，结果突出显示了即刻记忆缺陷。3周后进行的深入神经心理学评估包括韦氏成人智力量表第四版（WAIS-IV）、雷伊听觉词语学习测验（RAVLT）以及视觉空间技能、运动功能和记忆回忆测试。评估结果显示出明显的顺行性遗忘、持续的长期记忆不一致以及显著的执行功能挑战，详见表1。
对该病例的详细分析证实了大量使用物质可能导致的严重神经学后果。包括神经影像学和神经心理学评估在内的全面诊断评估对于阐明物质所致认知障碍的全貌至关重要。迫切需要提高公众意识并采取预防措施，尤其是在化学性爱背景下，以应对现代社会必须妥善应对的多方面健康、社会和政府影响。
