Huber W, Bautz W, Classen M, Schepp W
II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München.
Dtsch Med Wochenschr. 1995 Jan 20;120(3):60-4. doi: 10.1055/s-2008-1043200.
A 48-year-old man with known HIV infection for 4 years was admitted with a 2-week history of increasing brachio-facial paraesthesiae of the left side of the body and pains in the head and neck. Physical examination also showed discrete slowing of mental activity and oral candidiasis. Toxoplasmosis serology showed a low titre with a borderline IgM titre. Cranial computer tomography showed two confluent contrast medium concentrating foci in the region of the head of the caudate nucleus and the right internal capsule. Because toxoplasmosis encephalitis was suspected, treatment was started with sulfadiazine (1 g four times daily), pyrimethamine (25 mg four times daily), folic acid (15 mg daily) and dexamethasone (8 mg three times daily). After 19 days of treatment there was no clinical improvement, and a check CT scan showed worsening with increased oedema of the cerebellar medulla, compression of the lateral ventricles and a mid-line shift of 5 mm. Since the Sabin-Feldman test titre had increased, and there was no evidence to suggest a lymphoma or a viral or fungal infection, toxoplasmosis resistant to standard therapy was postulated, and treatment was started with clindamycin (600 mg three times daily) and pyrimethamine (25 mg four times daily). The clinical features subsided within 4 days. A further check CT scan 14 days later showed almost complete resolution.
一名已知感染艾滋病毒4年的48岁男子入院，其有为期2周的左侧臂面部感觉异常加重以及头部和颈部疼痛的病史。体格检查还显示精神活动明显迟缓以及口腔念珠菌病。弓形虫血清学检查显示滴度较低，IgM滴度处于临界值。头颅计算机断层扫描显示在尾状核头部和右侧内囊区域有两个融合的造影剂浓聚灶。由于怀疑为弓形虫脑炎，开始用磺胺嘧啶（每日4次，每次1 g）、乙胺嘧啶（每日4次，每次25 mg）、叶酸（每日15 mg）和地塞米松（每日3次，每次8 mg）进行治疗。治疗19天后临床症状无改善，复查CT扫描显示病情恶化，小脑延髓水肿加重，侧脑室受压，中线移位5 mm。由于Sabin-Feldman试验滴度升高，且没有证据提示淋巴瘤或病毒或真菌感染，推测为对标准治疗耐药的弓形虫病，开始用克林霉素（每日3次，每次600 mg）和乙胺嘧啶（每日4次，每次25 mg）进行治疗。临床症状在4天内消退。14天后再次复查CT扫描显示几乎完全恢复。
