人類後天免疫不全病毒感染患者合併瀰漫性淋巴球浸潤症候

Diffuse Infiltrative Lymphocytosis Syndrome in a Case of Human Immunodeficiency Virus Infection

HIV（human immunodeficiency virus）是一種稱為人類後天免疫不全的病毒，它是經由體液如血液或精液傳染。HIV感染者，產生的症狀為多樣化，初期如發燒、喉嚨疼痛、疲倦、胃口不佳、噁心、嘔吐、腹瀉。當HIV病毒數在血液中越來越多時， CD4+細胞的數量會因被破壞而減少。當CD4+細胞的數量降低到一定數量時，便會開始產生各種症狀包括吞嚥困難、舌部因黴菌（念珠感染、鵝口瘡或其他病毒）引起的白點、帶狀疱疹，淤青或流血的現象。本篇報告一位老年男性，無性病危險因子，初期症狀表現為疲累、體重減輕、黃疸、嚴重乾眼乾口症、嚴重慢性搔癢、發燒、低血壓、血球過低、血小板低下、淋巴腺及脾臟腫大。口內組織切片證實是修格連氏症候群、肝臟切片是膽道硬化、肋膜淋巴球浸潤、淋巴結呈現胚胎生發中心破壞，都符合自體免疫病之表現。但是病患對藥物治療反應不理想。最後經血清確定是愛滋病，而病患併發有敗血症及腎衰竭休克死亡。總結，由於HIV感染之症狀與自體免疫病極相似，又血液檢查也可能呈偽陽性反應，在愛滋病患逐年增加的今日，希望這病例報告可讓我們風濕科醫師更進一步了解這世紀疾病與免疫病之密切關係。

We present an illustrative case with human immunodeficiency virus (HIV) infection, who manifested with multiple autoimmune phenomena. Fatigue, body weight loss, jaundice, intense pruritus, erythematous macules over lower extremities, generalized lymphadenopathy, protracted fever and refractory hypotension, hypersplenism with pancytopenia (lymphocytopenia, anemia, and thrombocytopenia), and polyclonal gammopathy indicated immunological disorders. The patient's tissue biopsies showed Sjögren syndrome from inner lip, biliary cirrhosis from liver, marked plasma cell infiltration of pleura, and destruction of germinal centers but Jack of blast cells from lymph nodes. He denied all the risk factors including sexual promiscuity, receiving blood products, and drug abuse, which made the diagnosis difficult. This case highlights the great mimicking of autoimmunity in HIV infection and the rare persistent hypotension of unknown cause in HIV infection.