HIV陽性患者の稀な脾臓の1例

A Rare Case of Splenic in a HIV-Positive Patient.

• Hafsa Abbas
• Harish Patel
• Ahmed Baiomi
• Masooma Niazi
• Trupti Vakde
• Sridhar Chilimuri

抄録

症例紹介:

ヒト免疫不全ウイルス（HIV）陽性者で、CD4 数が 200 細胞/mm 未満の人は日和見感染症のリスクがあります。真菌性病原体であるHIVは、主に肺病変を伴う日和見感染症の一般的な原因となっています。肝脾臓病変を伴う播種性感染は極めてまれです。.HIVと後天性免疫不全症候群（AIDS）を合併した31歳の男性が3週間にわたり下痢を呈した。身体検査では脾腫と鼠径リンパ節腫脹を認めた。検査項目は貧血と低アルブミン血症，感染症の原因となる便検査と糞便白血球検査は陰性であった．胸部および腹部のCT検査では肺の圧迫と大きな脾臓腫瘤が認められた．気管支鏡検査と経気管支生検を受けたが，肺炎と診断された．脾臓腫瘤の超音波ガイド下コア生検ではGrocott-Gomori's methenamine silver (GMS)染色に感染を伴う壊死性肉芽腫が認められ，スルファメトキサゾールとトリメトプリムによる治療が開始された．

Introduction: Human immunodeficiency virus (HIV) positive individuals with the CD4 count less than 200 cells/mm are at risk for opportunistic infections. , a fungal pathogen, is a common cause of opportunistic infections with predominantly pulmonary involvement. Disseminated infection presenting with hepatosplenic lesion is extremely rare. . A 31-year-old male with HIV with and acquired immunodeficiency syndrome (AIDS) presented with diarrhea for 3 weeks. He had splenomegaly and inguinal lymphadenopathy on physical examination. Laboratory parameters revealed anemia and hypoalbuminemia, while stool studies for infectious etiology and fecal leucocyte were negative. Computed tomography (CT) of the chest and abdomen depicted consolidation of the lungs and a large splenic mass. He underwent fiberoptic bronchoscopy with transbronchial biopsy which was consistent with pneumonia. He also had a ultrasound-guided core biopsy of the splenic mass which revealed necrotizing granulomas with infection on Grocott-Gomori's methenamine silver (GMS) stain and was initiated on treatment for with sulfamethoxazole with trimethoprim.

結論:

肝脾臓病変を呈する患者では、悪性度と非定型感染が重要な鑑別要素となる。HIV陽性患者はAIDS関連リンパ腫のリスクが高い。さらなる評価のために組織診断が必要となることが多い。脾臓腫瘤および肝病変を伴う播種性は極めてまれである。

Conclusion: Malignancy and atypical infection are key differentials in patients presenting with hepatosplenic lesions. HIV positive patients are at increased risk of AIDS-related lymphoma. Tissue diagnosis is often required for further evaluation. Disseminated presenting with splenic mass and liver lesion is extremely rare.

Copyright © 2020 Hafsa Abbas et al.