Berman S M, Kim R C
Department of Internal Medicine, Veterans Affairs Medical Center, Long Beach, California 90822.
Am J Med. 1994 May;96(5):415-9. doi: 10.1016/0002-9343(94)90167-8.
Cytomegalovirus (CMV) retinitis in patients with the acquired immunodeficiency syndrome (AIDS) requires lifelong therapy with either intravenous ganciclovir sodium or foscarnet sodium. From June 1989 through February 1992, seven patients with AIDS were diagnosed to have CMV retinitis, and all were treated with ganciclovir. Five of the seven developed abrupt preterminal mental status changes. All five with mental status changes received anti-CMV therapy until the time of death. Autopsies were performed in all cases to determine the cause of mental status changes.
Five patients with AIDS and newly diagnosed CMV retinitis. Retrospective case analyses with autopsies. All five patients were treated with gangciclovir immediately upon the diagnosis of CMV retinitis and received ganciclovir at standard dosages until death.
Four patients had clinically stable retinitis throughout the entire course of ganciclovir therapy. In the fifth patient, because of fundoscopic deterioration, foscarnet therapy was initiated 1 month prior to death. Cerebrospinal fluid analysis and magnetic resonance imaging, although abnormal, were not diagnostically specific. Neuropathologic examination revealed fulminant diffuse CMV encephalitis in all patients, with prominent ependymal and periventricular necrosis.
These results suggest that while ganciclovir therapy may clinically stabilize CMV retinitis in patients with AIDS, it does not appear to prevent the development of, or be effective in the treatment of, CMV encephalitis. Thus, clinicians should consider the diagnosis of CMV encephalitis in patients receiving ganciclovir who develop mental status changes and, if possible, alter therapy accordingly.
获得性免疫缺陷综合征（AIDS）患者的巨细胞病毒（CMV）视网膜炎需要用静脉注射更昔洛韦钠或膦甲酸钠进行终身治疗。从1989年6月至1992年2月，7例AIDS患者被诊断为患有CMV视网膜炎，均接受了更昔洛韦治疗。7例中有5例出现了临终前突然的精神状态改变。所有5例有精神状态改变的患者在死亡前均接受了抗CMV治疗。所有病例均进行了尸检以确定精神状态改变的原因。
5例新诊断为CMV视网膜炎的AIDS患者。进行尸检的回顾性病例分析。所有5例患者在诊断为CMV视网膜炎后立即接受更昔洛韦治疗，并按标准剂量接受更昔洛韦治疗直至死亡。
4例患者在更昔洛韦治疗的整个过程中视网膜病变临床稳定。在第5例患者中，由于眼底镜检查结果恶化，在死亡前1个月开始了膦甲酸钠治疗。脑脊液分析和磁共振成像虽然异常，但并无诊断特异性。神经病理学检查显示所有患者均有暴发性弥漫性CMV脑炎，伴有明显的室管膜和脑室周围坏死。
这些结果表明，虽然更昔洛韦治疗可能使AIDS患者的CMV视网膜炎在临床上得到稳定，但它似乎不能预防CMV脑炎的发生，也不能有效治疗CMV脑炎。因此，临床医生应考虑对接受更昔洛韦治疗且出现精神状态改变的患者进行CMV脑炎的诊断，并尽可能相应地改变治疗方案。
