获得性免疫缺陷综合征合并脑弓形虫病误诊三例临床分析

Clinical Analysis of Misdiagnosis of Acquired Immune Deficiency Syndrome Complicated with Cerebral Toxoplasmosis in 3 Cases

目的探讨获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)合并脑弓形虫病的临床特点及误诊原因、防范措施。方法对曾误诊的AIDS合并脑弓形虫病3例的临床资料进行回顾性分析。结果 3例分别因右下肢乏力2周;间歇发热、视物模糊并视力进行性下降1年余;发热伴头痛、头晕、意识障碍,左侧肢体活动不便3 d入院。曾分别误诊为颅内多发性转移性肿瘤、弓形虫性视网膜葡萄膜炎、右侧颞叶转移性脑瘤,给予相应治疗效果不佳。后经相关实验室及CT、MRI等检查,均确诊为AIDS合并脑弓形虫病,予阿奇霉素、磺胺嘧啶及抗病毒等治疗。1例在治疗6个月后因病情加重合并肺部感染死亡;余2例在治疗后病情均有不同程度好转。结论 AIDS合并脑弓形虫病与多种疾病临床表现相似,易误诊。提高对该病认识、详细询问病史、认真体格检查、仔细鉴别诊断和及时行相关医技检查可减少或避免AIDS合并脑弓形虫病误诊。

Objective To investigate the clinical features,causes of misdiagnosis and preventive measures of acquired immunodeficiency syndrome（ AIDS） complicated with cerebral toxoplasmosis. Methods Retrospective analysis was performed on the clinical data of 3 cases of AIDS complicated with cerebral toxoplasmosis which had been misdiagnosed. Results Three patients presented to our department due to fatigue in the right lower limb for 2 weeks,intermittent fever,blurred vision and visual decline for more than 1 year,and fever,headache,dizziness,disturbance of consciousness and inactivity of left limb for 3 days,respectively. They were misdiagnosed as having intracranial multiple metastatic tumor,toxoplasmosis retinal uveitis,metastatic brain tumor of right temporal lobe,respectively,which were treated accordingly,producing unsatisfactory effects. Subsequently,based on related laboratory tests,CT and MRI examination,they were diagnosed with AIDS complicated with cerebral toxoplasmosis,and given antiviral therapy. One patient died of pulmonary infection due to exacerbation 6 months after treatment. After 2 weeks of treatment,the condition of the other two patients was improved to varying degrees. Conclusion Given similar clinical manifestations of AIDS complicated with cerebral toxoplasmosis to those of many diseases,the condition is easily misdiagnosed. Heightened perception of the disease,detailed medical history,careful physical examination and differential diagnosis,and timely medical tests can help to reduce or avoid misdiagnosis of AIDS complicated with cerebral toxoplasmosis.