渐进性多焦点白细胞脑病变模仿新诊断的HIV患者中风:一个病例报告
1Internal Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR.
Cureus
|December 22, 2025
概括
本案例研究详细介绍了一名56岁的妇女,被诊断患有渐进式多焦点白细胞脑病 (PML),这是由约翰·坎宁汉 (JC) 病毒引起的罕见脑病,在未被诊断的HIV感染的背景下. 该报告强调PML.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
背景情况:
- 渐进性多焦点白内障 (PML) 是一种罕见的,致命的中枢神经系统 (CNS) 脱髓化疾病.
- 在免疫功能低下的个体中,PML是由约翰·坎宁汉 (John Cunningham, JC) 病毒的重新激活引起的,通常是那些患有晚期艾滋病毒感染的人.
- 非典型的神经学表现可能会掩盖PML的诊断.
研究的目的:
- 在患者中报告PML模仿缺血性中风的病例,患者此前未被识别的艾滋病毒感染.
- 突出与非典型神经病态表现中的PML相关的诊断挑战.
- 强调在差异诊断中考虑与艾滋病毒相关的机会性感染的重要性.
主要方法:
- 一个56岁妇女的病例报告,她患有渐进性神经缺陷.
- 多学科评估包括放射学和脑脊液 (CSF) 分析.
- 在CSF中确认JC病毒以确定PML诊断.
主要成果:
- 患者出现左侧软弱,最初怀疑是缺血性中风.
- 放射学发现与最初的临床表现不一致.
- 检测到未诊断的HIV感染,并在CSF中确认了JC病毒,确定了PML诊断.
- 尽管接受了抗逆转录病毒治疗,但患者病情进一步恶化并死亡.
结论:
- 诊断PML可能是复杂的,特别是非典型的表现.
- 在患有异常神经症状的患者中,应考虑与艾滋病毒相关的机会性感染,如PML.
- 早期识别和管理潜在的免疫抑制对PML的结果至关重要,尽管晚期病例的预后仍然不佳.
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