与艾滋病毒相关的惠普尔病--病例报告

Gabriel Canhete Machado, Juliana Vinadé Portela, Elza Cristina Miranda da Cunha Bueno, Gustavo Gonzalez Real, Felipe Silveira Martins Sartori
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摘要

尽管缺乏讨论这一主题的文献,但惠普尔氏病(WD)在免疫力低下的人群中发病率较高,就像艾滋病病毒感染者一样。本病例报告了一名男性患者,中年,HIV 阳性,不规则使用抗逆转录病毒疗法(ART),在之前住院治疗气胸期间出现腹泻和吸收不良症状。 通过上消化道内窥镜对小肠进行活检,通过对周期性石蜡酸(PSA)进行免疫组化检查,可以诊断出患者感染了托菲瑞马-惠普莱氏菌,检查结果显示患者体内有泡沫状巨噬细胞,细胞质中富含 PSA 阳性颗粒。医疗措施是对假膜性结肠炎进行经验性治疗,包括联合使用美罗培南、万古霉素和甲硝唑。随着吸收不良临床症状的改善和腹泻次数的减少,患者康复出院。然而,这种疾病在艾滋病病毒感染者中的诊断率很低,在出现相关症状时应考虑患上腹泻,因为如果及时治疗,疾病的预后通常会很好。
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Doença de whipple associada ao HIV – relato de caso
Despite the lack of literature discussing the topic, the Whipple's Disease (WD) presents higher prevalence in people with compromised immunity, as it happens in HIV. This association can be seen in the current case, which reports a male patient, middle-aged, positive sorologic status for HIV with irregular use of antiretroviral therapy (ART) who presented symptoms of diarrhea and malabsorption during a previous hospitalization for pneumothorax treatment.  In a biopsy of the small intestine, by upper gastrointestinal endoscopy, the diagnosis of Tropheryma whipplei infection was possible through immunohistochemical examination for periodic-Shiff acid (PSA), with evidence of foamy macrophages with cytoplasm rich in PSA positive granules. The medical conduct was the empirical treatment for pseudomembranous colitis, which includes association of Meropenem, Vancomycin and Metronidazole. With the improvement of the clinical of malabsorption and the decrease of diarrheal episodes the patient got hospital discharge. Yet underdiagnosed in people living with HIV, the WD should be considered in the arise of compatible symptoms, because when treated on time the prognosis of the disease is usually favorable.  
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