以系统性血管炎表现为主的艾滋病报告

目的提高对艾滋病(acquired immune deficiency syndrome,AIDS)与结节性多动脉炎(polyarteritis nodosa,PAN)的鉴别诊断能力。方法回顾分析1例误诊为PAN的AIDS的临床资料,并复习相关文献。结果患者因反复发热、皮疹、乏力、头晕、头痛、全身关节酸痛、麻木及左耳听力丧失2年入院。病程中多次就诊或住院,均误诊。我院门诊经相关检查考虑PAN,收入风湿免疫科,经抗可溶性核抗原抗体谱、抗中性粒细胞胞浆抗体(ANCA)等检测均阴性,后经反复追问病史,了解到患者有冶游史和吸毒史,经人类免疫缺陷病毒抗体检测初筛试验和确诊试验确诊为AIDS。结论对以系统性血管炎表现为主但ANCA抗体阴性者,应警惕AIDS可能。

Acquired Immune Deficiency Syndrome with Mainifested Mainly by Systemic Vasculitis

Objective To improve the understanding clinical characteristics of Acquired Immunodeficiency Syndrome （AIDS） secondary necrotizing vasculitis and reduce misdiagnosis.Methods Clinical data of one AIDS patient,who had been misdiagnosed as having PAN,was retrospectively analyzed,and the related literature was reviewed.Results The patient was admitted for consistent fever,skin rash,acratia,dizziness,headache,systemic arthralgia,numbness and hearing loss of left ear for 2 years.The patients visited many times and was misdiagnosed during the course of disease.The patient was suspected with having PAN after related examinations in out-patient department,and was hospitalized in the department of rheumatology.The examinations of soluble nuclear antigen antibody spectrum and antineutrophil cytoplasm antibodies （ANCA） were negative.AIDS was confirmed with human immunodeficiency virus antibody of earlier screening test and confirmatory test and after repeated cross-examination of the case history of playing and use of illicit drugs.Conclusion Patients with the main symptoms of systemic vasculitis and negative ANCA antibodies should be suspected with having AIDS.