水痘-带状疱疹病毒（varicella-zoster virus，VZV）感染可累计神经系统，但是艾滋病（Acquired Immune Deficiency Syndrome，获得性免疫缺陷综合征）患者被VZV感染后并发脑梗死鲜有报道。本文报道一例艾滋病患者，初并发无疹性带状疱疹神经痛，经阿昔洛韦抗VZV治疗，止痛和必妥维抗HIV（Human Immunodeficiency Virus）治疗，好转出院。8日后患者发热伴言语不清恶心呕吐，腰穿和磁共振明确VZV相关脑膜脑炎，脑脊液VZV DNA达44251copies/mL，继续先后给予更昔洛韦联合膦甲酸钠，阿昔洛韦抗VZV，并地塞米松抗炎，好转后继续口服阿昔洛韦抗VZV。35日后该患者再发左侧额顶叶急性脑梗死致右侧肢体瘫痪，并失语，腰椎穿刺显示脑脊液VZV DNA 1200copies/mL。予更昔洛韦联合膦甲酸钠抗VZV，必妥维抗HIV，甲泼尼龙抗炎，阿司匹林抗血小板和阿托伐他汀稳定斑块等治疗好转。艾滋病患者合并VZV感染，可能导致脑梗死，因此要密切关注患者神经系统症状，降低此类患者致死率和致残率。
Abstract
Varicella-zoster virus (VZV) can infect the nervous system, but there are few reports of cerebral infarction caused by VZV in Acquired Immune Deficiency Syndrome (AIDS) patients. This paper reported a case of an AIDS patient who initially presented with herpes zoster neuralgia without a rash. After antiviral treatment with acyclovir for VZV, pain relief, and antiretroviral treatment with Bictegravir Sodium/Emtricitabine/Tenofovir Alafenamide Fumarate Tablets (BIC/FTC/TAF) for human immunodeficiency virus (HIV). The patient improved and was discharged. After 8 days, the patient developed a fever along with unclear speech, nausea, and vomiting. VZV-related meningoencephalitis was confirmed through lumbar puncture and magnetic resonance imaging. The VZV DNA in cerebrospinal fluid reached 44,251 copies/mL. Ganciclovir, foscarnet sodium, acyclovir (anti-VZV), and dexamethasone (anti-inflammatory) were administered sequentially. After improvement, acyclovir, an anti-VZV medication, was taken orally.Thirty five days later, the patient suffered from acute cerebral infarction in the left frontoparietal lobe, resulting in paralysis of the right limb and aphasia. Lumbar puncture showed that the cerebrospinal fluid contained 1200 copies/ml of VZV DNA. Ganciclovir combined with foscarnet sodium for anti-VZV, BIC/FTC/TAF for anti-HIV, methylprednisolone for anti-inflammatory purposes, aspirin for antiplatelet effects, and atorvastatin for plaque stabilization showed improvement. AIDS patients with VZV infection may develop cerebral infarction. Therefore, close attention should be paid to the patients with neurological symptoms to reduce the mortality and disability rate of such patients.
关键词
艾滋病 /
人类免疫缺陷病毒 /
水痘-带状疱疹病毒 /
脑梗死 /
脑膜脑炎 /
神经系统 /
无疹性带状疱疹
Key words
Acquired Immune Deficiency Syndrome /
Human immunodeficiency virus /
Varicella-zoster virus /
Cerebral Infarction /
Meningoencephalitis /
Nervous System /
Herpes Zoster without Rash
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