Acute renal injury in a 14-year-old with HIV/AIDS and tuberculosis.
Acute renal injury in a 14-year-old with HIV/AIDS and tuberculosis.
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一名患有艾滋病毒/艾滋病和肺结核的 14 岁青少年发生急性肾损伤。
DOI：
10.1097/inf.0b013e31829470f9
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Lowenthal,Elizabeth
中科院分区：
文献类型：
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作者：
Bosse,KristopherR;Russell,EricA;Chikwava,KudakwasheR;Rutstein,RichardM;Lowenthal,Elizabeth
一名14岁的男性，7年前从撒哈拉以南非洲移民到美国，最近被诊断患有艾滋病毒/艾滋病和播散性结核病，表现为病因不明的血清肌酐快速升高。他最初在大约1个月前到我们的机构就诊，有2个月的发热、全身不适、腹痛、体重减轻23磅和4个月的咳嗽。他被诊断为HIV/AIDS，发现初始绝对CD 4 + T淋巴细胞计数为227个细胞/μL（16.8%），HIV RNA水平为734，709拷贝/mL。当时，胸部、腹部和骨盆的计算机断层扫描显示双侧颈部和腋窝以及胸部和腹部多个部位广泛坏死性淋巴结病，沿着弥漫性粟粒性肺结节伴磨玻璃样混浊和几个小的低密度脾脏病变。左颈部淋巴结和右下肺结节活检分别显示广泛肉芽肿性淋巴结炎和肉芽肿性肺炎，均伴有罕见的抗酸杆菌。此外，几份痰液样本和一份支气管肺泡灌洗样本培养出结核分枝杆菌。因此，患者开始接受结核病治疗，包括利福平、异烟肼、吡嗪酰胺和乙胺丁醇。在开始结核病治疗后2周和当前表现前2周，还开始了拉米夫定、齐多夫定和依法韦仑的抗逆转录病毒治疗，但4天后，该方案转换为依法韦仑、恩曲他滨和替诺福韦（每日1粒; Atripla），以便于给药。值得注意的是，在开始抗逆转录病毒治疗前，肾脏超声显示肾脏大小和回声正常，无肾脏异常体征，患者血清肌酐（0.4 mg/dL）和尿液分析正常。在初次出院时，患者无发热，无腹痛，外周淋巴结肿大明显减少。
A 14-year-old male, who had immigrated to the United States from sub-Saharan Africa 7 years ago and was recently diagnosed with HIV/AIDS and disseminated tuberculosis, presented with a rapidly rising serum creatinine of unknown etiology. He had initially presented to our institution approximately 1 month before with 2 months of fever, general malaise, abdominal pain, a 23-pound weight loss and 4 months of cough. He was diagnosed with HIV/AIDS and found to have an initial absolute CD4+ T-lymphocyte count of 227 cells/μL (16.8%) and an HIV RNA level of 734,709 copies/mL. At that time, computed tomography scan of his chest, abdomen and pelvis demonstrated extensive necrotic adenopathy in his bilateral neck and axilla, as well as multiple sites within his thorax and abdomen, along with diffuse miliary pulmonary nodules with ground glass opacification and several small, hypodense splenic lesions. Biopsies of a left neck lymph node and a right lower lung pulmonary nodule showed extensive granulomatous lymphadenitis and a granulomatous pneumonia, respectively, both with rare acid-fast bacilli. In addition, several sputum samples and a broncheoalveolar lavage sample grew Mycobacterium tuberculosis. Consequently, the patient was started on tuberculosis therapy consisting of rifampin, isoniazid, pyrazinamide and ethambutol. Two weeks after initiating tuberculosis therapy and 2 weeks before the current presentation, antiretroviral therapy with lamivudine, zidovudine and efavirenz was also initiated, but 4 days later, the regimen was transitioned to efavirenz, emtricitabine and tenofovir (as 1 pill daily; Atripla) for ease of administration. Of note, before the start of antiretroviral therapy, a renal ultrasound revealed normal kidney size and echogenicity with no signs of renal abnormalities, and the patient had a normal serum creatinine (0.4 mg/dL) and urinalysis. At the time of initial discharge from our hospital, the patient was afebrile without abdominal pain and was noted to have a marked decrease in his peripheral lymphadenopathy.