Chetty K G, Kim R C, Mahutte C K
Medical Service, DVA Medical Center, Long Beach, California, USA.
Int J Tuberc Lung Dis. 1997 Dec;1(6):579-81.
A 45-year-old man with the acquired immune deficiency syndrome (AIDS) developed disseminated Mycobacterium tuberculosis infection and was started on isoniazid, rifampin, pyrazinamide and ethambutol. The treatment was interrupted because of side effects. On resumption of treatment be developed a rapidly progressive neurological illness characterized by left hemiparesis, right gaze preference, convulsions, coma, evidence of cerebral edema on computed tomography scan and death 9 days later. Autopsy showed the presence of miliary tuberculosis affecting the lungs, liver, spleen, lymph nodes and bone marrow. The brain showed evidence of acute hemorrhagic leukoencephalitis (AHL)-the first such case in a patient with AIDS. We speculate that treatment-induced lysis of mycobacteria with concomitant release of mycobacterial lipoproteins may have activated T-lymphocytes to cause AHL in this patient.
一名45岁的获得性免疫缺陷综合征（艾滋病）患者发生播散性结核分枝杆菌感染，开始接受异烟肼、利福平、吡嗪酰胺和乙胺丁醇治疗。治疗因副作用而中断。重新开始治疗后，他患上了一种快速进展的神经系统疾病，其特征为左侧偏瘫、右侧凝视偏好、惊厥、昏迷，计算机断层扫描显示有脑水肿迹象，9天后死亡。尸检显示肺部、肝脏、脾脏、淋巴结和骨髓存在粟粒性结核。脑部显示有急性出血性白质脑炎（AHL）的证据——这是艾滋病患者中的首例此类病例。我们推测，治疗引起的分枝杆菌溶解以及随之释放的分枝杆菌脂蛋白可能激活了T淋巴细胞，从而导致该患者发生AHL。
