Vasculite isolada do sistema nervoso central e acometimento do VIII nervo craniano manifestações raras da síndrome de imunodeficiência adquirida: an uncommon manifestation of AIDS

Boekel, Valentina Van; Assuf, Samira; Godoy, José Mauricio; Lamy, Luiz A.; Saraiva, Sonia B.

doi:10.1590/S0004-282X1992000100018

Resumos

O objetivo de nosso estudo é enfatizar a exuberante anarquia dos mecanismos imunológicos na síndrome de imunodeficiência adquirida. Tal anarquia propicia a eclosão de manifestações clínicas atípicas e, por vezes, bizarras, de difícil diagnóstico. No estudo em questão, chamamos a atenção para duas raras manifestações da doença: vasculite isolada do sistema nervoso central (SNC) e acometimento do> VIII nervo craniano, que exigem amplo diagnóstico diferencial, o que significa dizer intervenção de especialistas de diversas áreas. Após revisão da literatura, identificamos apenas dois casos de vasculite isolada do SNC induzida pelo vírus da imunodeficiência, humana e um caso de surdez neurossensorial comprovadamente ocasionada pelo retrovírus mencionado. Em passado longínquo, os médicos de boa formação clínica diziam ser necessário raciocinar «sifiliticamente» e hoje, diante de doença tão complexa e multissistêmica, nos parece necessário raciocinar «aideticamente».

SIDA; vasculite do sistema nervoso central; acometimento VIII nervo craniano

The authors report the case of an AIDS patient with rare neurologic manifestations: primary vasculitis of the central nervous system and VIII cranial nerve dysfunction. The authors make a review on the subject, and call special attention for the differential diagnosis. In fact, the patient, a 36 years old woman, with promiscuous life, presented with dizziness, gait ataxia, nausea, headache and hipoacusia. Seven days after the admission, she noted blurred vision in both eyes and soon she became blind. The physical examination showed bilateral optic neuritis and vestibulocochlear dysfunction, stiff neck and fever. No abnormalities were detected on CT scan. CSF showed 40 mononuclear cells/mm3, 79 mg/dl of proteins and normal glucose content. Microbiological research was negative. Serum anti-HIV test was positive. The hypothesis of primary CNS vasculitis was made, and pulse methylprednisolone therapy was introduced with good recovery of neurological syndrome except for persistent amaurosis.

AIDS; CNS vasculitis; VIII cranial nerve dysfunction

Valentina Van Boekel^I; Samira Assuf^I; José Mauricio Godoy^II; Luiz A. Lamy^III; Sonia B. Saraiva^IV

^IMédica, Clínica de Medicina Interna, Hospital de Ipanema

^IIProfessor Adjunto de Neurologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ)

^IIIMédico Chefe, Clínica de Medicina Interna, Hospital de Ipanema

^IVMédica Residente, Clínica de Medicina Interna, Hospital de Ipanema

RESUMO

O objetivo de nosso estudo é enfatizar a exuberante anarquia dos mecanismos imunológicos na síndrome de imunodeficiência adquirida. Tal anarquia propicia a eclosão de manifestações clínicas atípicas e, por vezes, bizarras, de difícil diagnóstico. No estudo em questão, chamamos a atenção para duas raras manifestações da doença: vasculite isolada do sistema nervoso central (SNC) e acometimento do> VIII nervo craniano, que exigem amplo diagnóstico diferencial, o que significa dizer intervenção de especialistas de diversas áreas. Após revisão da literatura, identificamos apenas dois casos de vasculite isolada do SNC induzida pelo vírus da imunodeficiência, humana e um caso de surdez neurossensorial comprovadamente ocasionada pelo retrovírus mencionado. Em passado longínquo, os médicos de boa formação clínica diziam ser necessário raciocinar «sifiliticamente» e hoje, diante de doença tão complexa e multissistêmica, nos parece necessário raciocinar «aideticamente».

Palavras chave: SIDA, vasculite do sistema nervoso central, acometimento VIII nervo craniano.

SUMMARY

The authors report the case of an AIDS patient with rare neurologic manifestations: primary vasculitis of the central nervous system and VIII cranial nerve dysfunction. The authors make a review on the subject, and call special attention for the differential diagnosis. In fact, the patient, a 36 years old woman, with promiscuous life, presented with dizziness, gait ataxia, nausea, headache and hipoacusia. Seven days after the admission, she noted blurred vision in both eyes and soon she became blind. The physical examination showed bilateral optic neuritis and vestibulocochlear dysfunction, stiff neck and fever. No abnormalities were detected on CT scan. CSF showed 40 mononuclear cells/mm3, 79 mg/dl of proteins and normal glucose content. Microbiological research was negative. Serum anti-HIV test was positive. The hypothesis of primary CNS vasculitis was made, and pulse methylprednisolone therapy was introduced with good recovery of neurological syndrome except for persistent amaurosis.

Wet words: AIDS, CNS vasculitis, VIII cranial nerve dysfunction.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dra. Valentina van Boekel Rua Osório Duque Estrada 74/902 B - 22451 Rio de Janeiro RJ -Brasil

1. Calabrese LH. The rheumatic manifestations of infection with the human immunodeficiency virus. Semin Arthritis Rheum 1989, 18:225-239.
2. Calabrese LH, Estes M, Yen-Lieberman B, Proffit MR, Tubbs R, Fishleder AJ, Levin KH. Systemic vasculitis in association with human immunodeficiency virus infection. Arthritis Rheum 1989, 32:569-576.
3. Cupps TR, Moore PM, Fauci AS. Isolated angiitis of the central nervous system: prospective diagnostic and therapeutic experience. Am J Med 1983, 74:97-105.
4. Engstrom JW, Lowenstein DH, Bredesen DE. Cerebral infarctions and transient neurologic deficits associated with acquired immunodeficiency syndrome. Am J Med 1989, 86:528-532.
5. Gherman CR, Ward RR, Bassis ML. Pneumocystis carinii otitis media and mastoiditis as the initial manifestation of the acquired immunodeficiency syndrome. Am J Med 1988, 85:250-252.
6. Gray F, Gherardi R, Scaravilli F. The neuropathology of the acquired immune deficiency syndrome (AIDS): a review. Brain 1988, 111:245-266.
7. Kaye BR, Fainstat M. Cerebral vasculitis associated with cocaine abuse. JAMA 1987, 258:2104-2106.
8. Kohan D, Rothstein SG, Cohen NL. Otologic disease in patients with acquired immunodeficiency syndrome. Ann Otol Rhinol Laryngol 1988, 97:636-640.
9. Levine SR, Welch KMA, Brust JCM. Cerebral vasculitis associated with cocaine abuse or subarachnoid hemorrhage? JAMA 1988, 259:1648-1649.
10. Levy RM, Bredesen DE, Rosenblum ML. Neurological manifestations of acquired immune deficiency syndrome (AIDS): experience at U.C.S.F. and review of the literature. J Neurosurg 1985, 62:475-486.
11. Moore PM, Cupps TR. Neurological complications of vasculitis. Ann Neurol 1983. 14:155-167.
12. Morris MS, Prasad S. Otologic disease in the acquired immunodeficiency syndrome. Ear Nose Throat J 1990, 69:451-453.
13. Moskowitz LB, Hensley GT, Chan JC, Conley FK, Post MJD, Gonzalez-Arias SM. Brain biopsies in patients with acquired immunedeficiency syndrome. Arch Pathol Lab Med 1984, 108:368-371.
14. Scaravilli F, Daniel SE, Harcourt-Webster N, Guiliff RJ. Chronic basal meningitis and vasculitis in acquired immunodeficiency syndrome: a possible role for human immunodeficiency virus. Arch Pathol Lab Med 1989, 113:192-195.
15. Schwartz ND, So YT, Hollander H, Allen S, Fye KH. Eosinophilic vasculitis leading to amaurosis fugax in a patient with acquired immunodeficiency syndrome. Arch Intern Med 1986, 146:2059-2060.
16. Smith ME, Canalis RF. Otologic manifestations of AIDS: the otosyphilis connection. Laryngoscope 1989, 99:365-372.
17. Stern JC, Lin P-T, Lucente FE. Benign nasopharyngeal masses and human immunodeficiency virus infection. Arch Otolaryngol Head Neck Surg 1990, 116:206-208.
18. Timon CI, Walsh MA. Sudden sensorineural hearing loss as a presentation of HIV infection. J Laryngol Otol 1989, 103:1071-1072.
19. Tanker BA, Skolnik PR, Shoukimas GM, Gabuzda DH, Sobel RA, Ho DD. Cerebral granulomatous angiitis associated with isolation of human T lymphotropic virus type III from the central nervous system. Ann Neurol 1986, 20:362-366.

Vasculite isolada do sistema nervoso central e acometimento do VIII nervo craniano manifestações raras da síndrome de imunodeficiência adquirida

Primary central nervous system vasculitis and eight cranial nerve dysfunction: an uncommon manifestation of AIDS

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Mar 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Calabrese LH. The rheumatic manifestations of infection with the human immunodeficiency virus. Semin Arthritis Rheum 1989, 18:225-239.

[2] 2. Calabrese LH, Estes M, Yen-Lieberman B, Proffit MR, Tubbs R, Fishleder AJ, Levin KH. Systemic vasculitis in association with human immunodeficiency virus infection. Arthritis Rheum 1989, 32:569-576.

[3] 3. Cupps TR, Moore PM, Fauci AS. Isolated angiitis of the central nervous system: prospective diagnostic and therapeutic experience. Am J Med 1983, 74:97-105.

[4] 4. Engstrom JW, Lowenstein DH, Bredesen DE. Cerebral infarctions and transient neurologic deficits associated with acquired immunodeficiency syndrome. Am J Med 1989, 86:528-532.

[5] 5. Gherman CR, Ward RR, Bassis ML. Pneumocystis carinii otitis media and mastoiditis as the initial manifestation of the acquired immunodeficiency syndrome. Am J Med 1988, 85:250-252.

[6] 6. Gray F, Gherardi R, Scaravilli F. The neuropathology of the acquired immune deficiency syndrome (AIDS): a review. Brain 1988, 111:245-266.

[7] 7. Kaye BR, Fainstat M. Cerebral vasculitis associated with cocaine abuse. JAMA 1987, 258:2104-2106.

[8] 8. Kohan D, Rothstein SG, Cohen NL. Otologic disease in patients with acquired immunodeficiency syndrome. Ann Otol Rhinol Laryngol 1988, 97:636-640.

[9] 9. Levine SR, Welch KMA, Brust JCM. Cerebral vasculitis associated with cocaine abuse or subarachnoid hemorrhage? JAMA 1988, 259:1648-1649.

[10] 10. Levy RM, Bredesen DE, Rosenblum ML. Neurological manifestations of acquired immune deficiency syndrome (AIDS): experience at U.C.S.F. and review of the literature. J Neurosurg 1985, 62:475-486.

[11] 11. Moore PM, Cupps TR. Neurological complications of vasculitis. Ann Neurol 1983. 14:155-167.

[12] 12. Morris MS, Prasad S. Otologic disease in the acquired immunodeficiency syndrome. Ear Nose Throat J 1990, 69:451-453.

[13] 13. Moskowitz LB, Hensley GT, Chan JC, Conley FK, Post MJD, Gonzalez-Arias SM. Brain biopsies in patients with acquired immunedeficiency syndrome. Arch Pathol Lab Med 1984, 108:368-371.

[14] 14. Scaravilli F, Daniel SE, Harcourt-Webster N, Guiliff RJ. Chronic basal meningitis and vasculitis in acquired immunodeficiency syndrome: a possible role for human immunodeficiency virus. Arch Pathol Lab Med 1989, 113:192-195.

[15] 15. Schwartz ND, So YT, Hollander H, Allen S, Fye KH. Eosinophilic vasculitis leading to amaurosis fugax in a patient with acquired immunodeficiency syndrome. Arch Intern Med 1986, 146:2059-2060.

[16] 16. Smith ME, Canalis RF. Otologic manifestations of AIDS: the otosyphilis connection. Laryngoscope 1989, 99:365-372.

[17] 17. Stern JC, Lin P-T, Lucente FE. Benign nasopharyngeal masses and human immunodeficiency virus infection. Arch Otolaryngol Head Neck Surg 1990, 116:206-208.

[18] 18. Timon CI, Walsh MA. Sudden sensorineural hearing loss as a presentation of HIV infection. J Laryngol Otol 1989, 103:1071-1072.

[19] 19. Tanker BA, Skolnik PR, Shoukimas GM, Gabuzda DH, Sobel RA, Ho DD. Cerebral granulomatous angiitis associated with isolation of human T lymphotropic virus type III from the central nervous system. Ann Neurol 1986, 20:362-366.