人类免疫缺陷病毒-1感染急性期双侧面神经麻痹合并脑膜炎1例

doi:10.24920/003460

摘要/Abstract

摘要：

本研究报道了1例人类免疫缺陷病毒(HIV)感染出现双侧周围性面神经麻痹的病例。一名38岁的男性同性恋患者因双侧面瘫来我院就诊，入院前21天，患者出现高热(达39℃)、畏寒、头痛、疲劳、全身不适、恶心、呕吐等症状。神经系统检查显示:双侧周围性面神经麻痹，双唇和双侧脸颊下垂，双眼睑闭合不全。脑脊液检查结果显示：细胞数增多，微量总蛋白含量显著升高，脑脊液中鞘内IgG合成明显增多。ELISA初筛检测显示HIV-1血清学呈阳性，Western blot进一步确认了阳性结果。CD4⁺细胞计数为180/mm³。脑脊液病毒载量为血浆病毒载量的10倍。患者的健康状况不断改善，双侧面神经麻痹于2个月后完全缓解。

关键词: 人类免疫缺陷病毒, 获得性免疫缺陷综合征, 急性人类免疫缺陷病毒1感染, 周围性面神经麻痹, 双侧面神经麻痹

Abstract:

Here we reported a Chinese case of bilateral peripheral facial paralysis (PFP) in human immunodeficiency virusc (HIV) infected population. A 38-year-old homosexual male patient was referred to our hospital for bilateral facial paralysis. 21 days prior to admission he had developed high fever, chills, headache, fatigue, general malaise, nausea and vomiting. Neurological examination revealed bilateral ptosis of lower lip and cheeks, as well as failure of bilateral eyes closure. Analysis of cerebrospinal fluid (CSF) revealed pleocytosis, a marked rise of micro total protein and a marked rise of intrathecal lgG synthesis. The result of HIV-1 serology was positive by ELISA and that was confirmed by western blot. His CD4 ⁺ cell count was 180 cells/mm ³. HIV-1 viral load in CSF was almost 10 times higher than that in plasma. The patient’s condition improved steadily and experienced complete resolution of bilateral PFP after 2 months.

Key words: human immunodeficiency virus, acquired immune deficiency syndrome, acute human immunodeficiency virus-1 infection, peripheral facial paralysis

Wu Yan, Song Ge, Wei Chunbo, Lun Wenhui. Bilateral Peripheral Facial Paralysis Combined with HIV Meningitis During Acute HIV-1 Infection: A Case Report[J].Chinese Medical Sciences Journal, 2019, 34(1): 55-59.

图/表 1

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Examination items	Before treatment	After treatment	Normal range
Blood biochemistry
White blood cell (cells/L)	11.47×10⁹	5.09×10⁹	(4-10)×10⁹
Alanine transaminase (U/L)	49	35	0-40
CSF
Micro total protein (g/L)	1.27	0.41	0-0.4
Chloride (mmol/L)	113.9	119.2	118-129
lgG synthesis (mg/24 h)	41.85	25.67	<7.0
lgG index	0.95	0.84	<0.85
Permeability of blood-brain barrier	18.61×10^-3	8.09×10^-3	<5.0×10^-3
MBP (μg/L)	4.02	2.47	<3.5
HIV viral load (copies/ml)	95 575	260	TND
Full blood
CD4 (cells/mm³)	180	466	706-1125
CD8 (cells/mm³)	1454	1215	323-836
CD4/CD8	0.12	0.38	1.0-2.0
Plasma
HIV viral load (copies/ml)	9903	9895	TND

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