Opportunistic penicilliosis infection causing intestinal obstruction in people living with HIV complicating antiretroviral therapy
Opportunistic penicilliosis infection causing intestinal obstruction in people living with HIV complicating antiretroviral therapy
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DOI：
10.1136/bcr-2019-230121
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发表时间：
2020-02-01
期刊：
影响因子：
0.9
通讯作者：
Chase, Suchita
中科院分区：
文献类型：
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作者：
Sridhar, Rajeevan Philip;Coelho, Victor Vijay;Chase, Suchita
我们报告了一名逆转录病毒阳性患者，该患者出现反复出现的皮肤损伤以及间歇性绞痛性脐周腹痛，并伴有非喷射性餐后呕吐。腹部和骨盆增强 CT (CECT) 提示近端空肠梗阻。双气囊小肠镜检查显示距幽门 60 厘米处有广泛的深层溃疡，周围有结节状表面和脆弱的粘膜，管腔变窄。该区域的活组织检查以及前额的皮肤损伤处生长有马尔尼菲Talaromyces marneffei。她最初接受脂质体两性霉素 B 治疗 2 周，随后接受伊曲康唑 3 周治疗播散性踝部真菌感染。一年前，她已经开始接受抗逆转录病毒治疗 (ART)，但她的分化簇 4 (CD4) 计数没有显示任何改善。近端肠梗阻导致营养状况不佳，再加上由于吸收欠佳而导致 ART 治疗无效，因此需要对她的病情进行阶段性管理。营养空肠造口术是根据计划进行的，在优化她的营养和免疫状态后，如果她需要的话，可以对受影响的空肠段进行切除和吻合。
We report a retroviral positive patient who presented to us with recurrent skin lesions along with intermittent, colicky periumbilical abdominal pain associated with non-projectile, postprandial vomiting. Contrast-enhanced CT (CECT) of abdomen and pelvis was suggestive of proximal jejunal obstruction. Double balloon enteroscopy done which showed extensive deep ulceration with surrounding nodular surface and friable mucosa at 60cm from pylorus with luminal narrowing. The biopsy from this region as well as the skin lesion on the forehead grew Talaromyces marneffei. She was initially treated with liposomal amphotericin B for 2weeks following which she received itraconazole for 3weeks for disseminated talaromycosis infection. She had already been started on antiretroviral therapy (ART) 1year back however her cluster of differentiation 4 (CD4) counts did not show any improvement. Proximal bowel obstruction leading to poor nutritional status compounded with ineffective ART therapy due to suboptimal absorption, dictated the staged management of her condition. Feeding jejunostomy was done with a plan to offer her resection and anastomosis of affected jejunal segment, should she require one, after optimising her nutritional and immunological status.