Flaccid quadriplegia in an AIDS patient
Autor(a) principal: | |
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Data de Publicação: | 1995 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://revista.spmi.pt/index.php/rpmi/article/view/2414 |
Resumo: | A 29 years old heterosexual caucasian male, former intravenous drug users, HIV 1+, with AIDS diagnosed 10 months before (pulmonary tuberculosis - CDC C3) was admited in our ward for the first time in November 93 with a voluntary intoxication with isoniazid (13,5 gr) and rifampin (27 gr). He was treated with high doses of pyridoxine (5 gr) without any immediate complications. One month later an ascending progressive flaccid quadriplegia requiring mechanical ventilation was developed in four days. He had fever, meningeal irritation signs, no cognitive impairment and sensory anaesthesia below T4 leveL CSF showed pleocytosis with predominant polymorphonuclear leukocytes, elevated protein, and IgA intrathecal syntesis. The immunological serum and CSF exami nation gave no evidence of recent infection with herpes vírus, Toxoplasma gondii or Cryptococcus neoformans direct and cultural CSF examination revealed no acid-fast bacilli. The CT scan revealed cervical spinal cordenlar gement with partial subarachnoidal space obliteration at C3 level. The somatosensory evoked responses suggested spinal cord blocking. The electromyography revealed a peripheral polyneuropathy with a demyelinating component. The patient was initially treated with gancyclovir without clinical improvement and, in face of the results mentioned above, corticoid therapy was instituted. Four months later there was a partial recovery ( upper limbs muscular strenght grade 3, lower limbs grade 1, autonomous breathing and TIO sensory level). At this time, repeated immunological serum examination revealed IgM positive for CMV in two determinations. The authors admit, on the basis of the clinicai and CSF pathern, a cytomegalovirus radiculomyelopathy with associated peripheral polyneuropathy in the context of advanced stage HIV injection ( AIDS CDCC3). |
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Flaccid quadriplegia in an AIDS patientTetraplegia flácida em doente com SIDAtetraplegiaSIDAmielorradiculopatiapolineuropatia periféricaquadriparesiaAIDSCMVperipheral polyneuropathyradiculomeyelopathyA 29 years old heterosexual caucasian male, former intravenous drug users, HIV 1+, with AIDS diagnosed 10 months before (pulmonary tuberculosis - CDC C3) was admited in our ward for the first time in November 93 with a voluntary intoxication with isoniazid (13,5 gr) and rifampin (27 gr). He was treated with high doses of pyridoxine (5 gr) without any immediate complications. One month later an ascending progressive flaccid quadriplegia requiring mechanical ventilation was developed in four days. He had fever, meningeal irritation signs, no cognitive impairment and sensory anaesthesia below T4 leveL CSF showed pleocytosis with predominant polymorphonuclear leukocytes, elevated protein, and IgA intrathecal syntesis. The immunological serum and CSF exami nation gave no evidence of recent infection with herpes vírus, Toxoplasma gondii or Cryptococcus neoformans direct and cultural CSF examination revealed no acid-fast bacilli. The CT scan revealed cervical spinal cordenlar gement with partial subarachnoidal space obliteration at C3 level. The somatosensory evoked responses suggested spinal cord blocking. The electromyography revealed a peripheral polyneuropathy with a demyelinating component. The patient was initially treated with gancyclovir without clinical improvement and, in face of the results mentioned above, corticoid therapy was instituted. Four months later there was a partial recovery ( upper limbs muscular strenght grade 3, lower limbs grade 1, autonomous breathing and TIO sensory level). At this time, repeated immunological serum examination revealed IgM positive for CMV in two determinations. The authors admit, on the basis of the clinicai and CSF pathern, a cytomegalovirus radiculomyelopathy with associated peripheral polyneuropathy in the context of advanced stage HIV injection ( AIDS CDCC3).Os autores descrevem o caso clínico de um doente de 29 anos, sexo masculino, heterossexual toxicodependente EV a opiáceos, com o diagnóstico de síndroma de imunodeficiência adquirida (SIDA) efectuado 10 meses antes. Foi internado pela primeira vez no Serviço por intoxicação voluntária com isoniazida (13,5 g) e rif mpicina (27 g), sem complicações, tratada com megadoses de piridoxina (5 g). Um mês depois, desenvolveu-se, em quatro dias, tetraplegia flácida ascendente e progressiva com nível de sensibilida de em D4 e insuficiência respiratória. O exame do liquor revelou pleocitose com predomínio de polimorfonucleares (PMN), aumento da concentração de proteínas e padrão francamente inflamatório com síntese intratecal de imunoglobu linas (Igs). Os estudos complementares efectuados inicial mente não permitiram identificar nenhum agente patogénico associado, embora se tenha verificado tardiamente (3 meses) o aparecimento de IgM + para citomegalovírus (CMV). O estudo tomográfico computorizado da coluna cervical revelou aumento das dimensões dos segmentos médio/alto da medula cervical com obliteração parcial do espaço subaracnóide a nível de C3. Os potenciais evocados somato-sensitivos e o estudo electromiográfico mostraram um bloqueio de condução medular e a existência de uma polineuropatia periférica sensitivo-motora com componente desmielinizante. São discutidos os principais diagnósticos diferenciais a colocar perante este quadro clínico, concluindo-se como provável a existência de mielorradi culopatia a CMV com polineuropatia periférica associada, em contexto de infecção avançada pelo VIH.Sociedade Portuguesa de Medicina Interna1995-12-29info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://revista.spmi.pt/index.php/rpmi/article/view/2414Internal Medicine; Vol. 2 No. 4 (1995): Outubro/ Dezembro; 255-258Medicina Interna; Vol. 2 N.º 4 (1995): Outubro/ Dezembro; 255-2582183-99800872-671Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spmi.pt/index.php/rpmi/article/view/2414https://revista.spmi.pt/index.php/rpmi/article/view/2414/1745Direitos de Autor (c) 1995 Medicina Internainfo:eu-repo/semantics/openAccessCosta, H.Matos, R.Teófilo, E.Aguiar, C.Poole da Costa, J. A.2023-10-07T06:21:31Zoai:oai.revista.spmi.pt:article/2414Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:33:38.722890Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Flaccid quadriplegia in an AIDS patient Tetraplegia flácida em doente com SIDA |
title |
Flaccid quadriplegia in an AIDS patient |
spellingShingle |
Flaccid quadriplegia in an AIDS patient Costa, H. tetraplegia SIDA mielorradiculopatia polineuropatia periférica quadriparesia AIDS CMV peripheral polyneuropathy radiculomeyelopathy |
title_short |
Flaccid quadriplegia in an AIDS patient |
title_full |
Flaccid quadriplegia in an AIDS patient |
title_fullStr |
Flaccid quadriplegia in an AIDS patient |
title_full_unstemmed |
Flaccid quadriplegia in an AIDS patient |
title_sort |
Flaccid quadriplegia in an AIDS patient |
author |
Costa, H. |
author_facet |
Costa, H. Matos, R. Teófilo, E. Aguiar, C. Poole da Costa, J. A. |
author_role |
author |
author2 |
Matos, R. Teófilo, E. Aguiar, C. Poole da Costa, J. A. |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Costa, H. Matos, R. Teófilo, E. Aguiar, C. Poole da Costa, J. A. |
dc.subject.por.fl_str_mv |
tetraplegia SIDA mielorradiculopatia polineuropatia periférica quadriparesia AIDS CMV peripheral polyneuropathy radiculomeyelopathy |
topic |
tetraplegia SIDA mielorradiculopatia polineuropatia periférica quadriparesia AIDS CMV peripheral polyneuropathy radiculomeyelopathy |
description |
A 29 years old heterosexual caucasian male, former intravenous drug users, HIV 1+, with AIDS diagnosed 10 months before (pulmonary tuberculosis - CDC C3) was admited in our ward for the first time in November 93 with a voluntary intoxication with isoniazid (13,5 gr) and rifampin (27 gr). He was treated with high doses of pyridoxine (5 gr) without any immediate complications. One month later an ascending progressive flaccid quadriplegia requiring mechanical ventilation was developed in four days. He had fever, meningeal irritation signs, no cognitive impairment and sensory anaesthesia below T4 leveL CSF showed pleocytosis with predominant polymorphonuclear leukocytes, elevated protein, and IgA intrathecal syntesis. The immunological serum and CSF exami nation gave no evidence of recent infection with herpes vírus, Toxoplasma gondii or Cryptococcus neoformans direct and cultural CSF examination revealed no acid-fast bacilli. The CT scan revealed cervical spinal cordenlar gement with partial subarachnoidal space obliteration at C3 level. The somatosensory evoked responses suggested spinal cord blocking. The electromyography revealed a peripheral polyneuropathy with a demyelinating component. The patient was initially treated with gancyclovir without clinical improvement and, in face of the results mentioned above, corticoid therapy was instituted. Four months later there was a partial recovery ( upper limbs muscular strenght grade 3, lower limbs grade 1, autonomous breathing and TIO sensory level). At this time, repeated immunological serum examination revealed IgM positive for CMV in two determinations. The authors admit, on the basis of the clinicai and CSF pathern, a cytomegalovirus radiculomyelopathy with associated peripheral polyneuropathy in the context of advanced stage HIV injection ( AIDS CDCC3). |
publishDate |
1995 |
dc.date.none.fl_str_mv |
1995-12-29 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://revista.spmi.pt/index.php/rpmi/article/view/2414 |
url |
https://revista.spmi.pt/index.php/rpmi/article/view/2414 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revista.spmi.pt/index.php/rpmi/article/view/2414 https://revista.spmi.pt/index.php/rpmi/article/view/2414/1745 |
dc.rights.driver.fl_str_mv |
Direitos de Autor (c) 1995 Medicina Interna info:eu-repo/semantics/openAccess |
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Direitos de Autor (c) 1995 Medicina Interna |
eu_rights_str_mv |
openAccess |
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application/pdf |
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Sociedade Portuguesa de Medicina Interna |
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Sociedade Portuguesa de Medicina Interna |
dc.source.none.fl_str_mv |
Internal Medicine; Vol. 2 No. 4 (1995): Outubro/ Dezembro; 255-258 Medicina Interna; Vol. 2 N.º 4 (1995): Outubro/ Dezembro; 255-258 2183-9980 0872-671X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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