1987 Volume 18 Issue 2 Pages 263-270
A 44-year-old man was diagnosed to have hemophilia A when he was 6 years old. A large quantity of highly purified Factor VIII preparation was transfused in 1980 and 1983 for the treatment of hemophilia. The patient had been well until August 1985 when he was aware of general fatigue. Slight fever, anorexia, night sweat, diarrhea and dysesthesia in the extremities appeared from January 1986. Owing to high fever, chronic diarrhea and severe cough continued from the begining of May, he was admitted to our hospital on May 15, 1986. On admission, he was emaciated (height 173cm, weight 50kg). Body temperature was 38.6℃. Cervical lymphadenopathy was palpable bilaterally. Moist rales in the chest and hepatomegaly were detected. In neurological examination, consciousness was clear and cranial nerves were normal. Meningeal sign was negative. There were sensory disturbances which showed the type of polyneuropathy. Deep reflexes were reduced. Pathological reflexes were negative. In laboratory examinations, the leucocyte count was 4700/μl and the total lymphocyte count was 470/μl in peripheral blood. Biochemistry showed liver damage and increased γ-globulin. There were a remarkable decrease in T4 cell count and a marked reduction of OKT4/OKT8. IgG, IgA and IgM were increased. Tuberculin test was negative. Human immunodeficiency virus (HIV) antibody was positive. The first chest X-P disclosed sporadic nodular shadows in the both lungs, especially in the left Ss region. After one week, chest X-P revealed pleural effusion, from which mycobacterium tuberculosis was detected. Brain CT scan showed low density area in the left parietal lobe. There were diffuse slow waves of low voltage in EEG. No evidence of Kaposi's sarcoma was found. The patient was diagnosed to have been suffering from acquired immunodeficiency syndrome (AIDS). Remarkable cellular immunodeficiency and several opportunistic infections with positive HIV antibody were considered to account for his severe state. He died two weeks after admission. In the literature of U.S.A., pneumocystis carinii pneumonia is the most common in pulmonary complications of AIDS. But tuberculosis is also seen occasionally. Neurological complications have high frequency. Approximately one-third of AIDS patients have neurological complications, and moreover, the initial symptoms are neurological in 10% of all AIDS patients. Damage to the central nervous system is frequent. But peripheral neuropathy is also seen occasionally. So far 26 AIDS patients were detected in Japan. But neurological complications and pulmonary tuberculosis in AIDS, both of which were confirmed in our patient, seem to be presently very rare in Japan.
