CASE DESCRIPTION:A 38-year-old man presented with headaches and generalized weakness. He was found to have AIDS; a ring-enhancing central nervous system lesion was found on brain imaging and he had elevated serum Toxoplasma gondii IgG levels. A diagnosis of presumptive toxoplasma encephalitis was made and he received antiretrovirals and antitoxoplasma therapy for 4 years. Intermittent headaches and evidence of disease progression on neuroimaging warranted further evaluation and cerebrospinal fluid analysis revealed amebic forms on hematoxylin and eosin staining and positive polymerase chain reaction testing for Acanthamoeba spp. He was placed on miltefosine, fluconazole, trimethoprim-sulfamethoxazole and flucytosine for 7 months. Five months after therapy discontinuation he remains asymptomatic and is taking only antiretroviral therapy. CONCLUSION:This is the first report of a patient with AIDS and granulomatous amebic encephalitis who survived with medical therapy only.

译文

病例描述:一名38岁的男性出现头痛和全身无力。他被发现患有艾滋病;在大脑成像中发现了增强环的中枢神经系统病变,他的血清弓形虫IgG水平升高。诊断为推定性弓形虫脑炎,他接受了抗逆转录病毒药物和抗弓形虫疗法治疗了4年。间歇性头痛和神经影像学上疾病进展的证据值得进一步评估,脑脊液分析显示苏木精和曙红染色中的阿米巴形式以及棘阿米巴属菌种的阳性聚合酶链反应测试。他被放置在miltefosine,fluconazole,trimethoprim-sulfamethoxazole和flucytosine上7个月。停药五个月后,他无症状,仅接受抗逆转录病毒疗法。
结论:这是第一例仅通过药物治疗幸存下来的艾滋病和肉芽肿性阿米巴脑炎患者的报告。

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