Dudle G, Opravil M, Lüthy R, Weber R
Abteilung Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich.
Dtsch Med Wochenschr. 1997 Sep 26;122(39):1178-80. doi: 10.1055/s-2008-1047745.
A 39-year-old HIV positive patient developed myalgia, headache and cough 4 weeks after a tick bite. His temperature was 37.4 degrees C and a circular pale erythema was noted over the left lower leg.
C-reactive protein was raised to 120 mg/l, white blood cell count was 5860/microliter, CD4-lymphocyte count 250/microliter. The chest radiogram showed pneumonitic infiltration in the left lower lobe. There were IgM antibodies against Borrelia burgdorferi.
Left lower lobe pneumonia and chronic erythema migrans were diagnosed and he was given oral azithromycin (500 mg on the first day and 250 mg for 4 days). The pneumonia cleared up, but 2 weeks later he developed symptoms of meningitis (496 cells per microliter, 87% lymphocytes, positive Borrelia burgdorferi antibody titer), which quickly and lastingly responded to ceftriaxon (2 g daily by brief infusion for 14 days).
This immune-compromised HIV-infected patient developed disseminated borreliosis with CNS involvement 2 weeks after the occurrence of chronic erythema migrans. The initial treatment of the latter with azithromycin was unable to prevent the meningitis. It is unlikely that there was a causal connection between the borreliosis and the pneumonia.
一名39岁的HIV阳性患者在被蜱虫叮咬4周后出现肌痛、头痛和咳嗽。体温为37.4摄氏度，左小腿发现一个圆形淡红色皮疹。
C反应蛋白升高至120mg/L，白细胞计数为5860/微升，CD4淋巴细胞计数为250/微升。胸部X光片显示左下叶有肺炎浸润。存在抗伯氏疏螺旋体的IgM抗体。
诊断为左下叶肺炎和慢性游走性红斑，给予口服阿奇霉素（首日500mg，后4天每日250mg）。肺炎得以治愈，但2周后他出现脑膜炎症状（每微升496个细胞，87%为淋巴细胞，伯氏疏螺旋体抗体滴度呈阳性），头孢曲松（每日2g，静脉滴注14天）治疗后症状迅速且持久缓解。
这名免疫功能低下的HIV感染患者在慢性游走性红斑出现2周后发生了播散性莱姆病并累及中枢神经系统。最初用阿奇霉素治疗慢性游走性红斑未能预防脑膜炎的发生。莱姆病与肺炎之间不太可能存在因果关系。
