RESUMO
A child with vertical transmission of human immunodeficiency virus refractory to therapy developed zoster-induced protein S deficiency and recurrent strokes. Extensive carotid arteritis was found postmortem. The carotid tissue was positive for herpes varicella zoster by polymerase chain reaction, as were immunofixation stains of the arterial wall.
Assuntos
Síndrome da Imunodeficiência Adquirida/diagnóstico , HIV-1/patogenicidade , Herpesvirus Humano 3/patogenicidade , Transmissão Vertical de Doenças Infecciosas , Infecção pelo Vírus da Varicela-Zoster/diagnóstico , Vasculite do Sistema Nervoso Central/diagnóstico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/transmissão , Síndrome da Imunodeficiência Adquirida/virologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Artérias Carótidas/patologia , Artérias Carótidas/virologia , Pré-Escolar , Tolerância a Medicamentos , Evolução Fatal , Feminino , HIV-1/crescimento & desenvolvimento , Herpesvirus Humano 3/crescimento & desenvolvimento , Humanos , Deficiência de Proteína S/diagnóstico , Deficiência de Proteína S/patologia , Deficiência de Proteína S/virologia , Recidiva , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/virologia , Infecção pelo Vírus da Varicela-Zoster/patologia , Infecção pelo Vírus da Varicela-Zoster/virologia , Vasculite do Sistema Nervoso Central/patologia , Vasculite do Sistema Nervoso Central/virologiaRESUMO
Risk of cerebrovascular disease is increased in patients with HIV infection; however, cerebral venous sinus thrombosis is not commonly reported in this condition. We report a case of young man with intracranial hemorrhage whose radiologic investigations revealed thrombosis of the left transverse and sigmoid sinuses extending into the left internal jugular vein. On further investigations, he was found to be positive for HIV-1, and his procoagulant workup showed protein S deficiency. He was started on anticoagulant therapy, after which he showed gradual recovery. This case highlights a rarely encountered presentation of HIV infection as cerebral venous sinus thrombosis.
Assuntos
Infecções por HIV/diagnóstico , Trombose dos Seios Intracranianos/etiologia , Adulto , Infecções por HIV/complicações , Humanos , Masculino , Deficiência de Proteína S/complicações , Deficiência de Proteína S/diagnóstico , Deficiência de Proteína S/virologia , Trombose dos Seios Intracranianos/diagnósticoRESUMO
BACKGROUND: Varicella zoster virus (VZV) infection can cause temporary acquired protein S or C deficiency via cross reacting antibodies and consequently inducing a hypercoagulable state. CASE DESCRIPTION: A 6-year-old girl with a history of congenital cardiac disease was seen at an Emergency Department with acute chest pain, dyspnoea and fever, seven days after developing chicken pox. Diagnostic tests revealed massive infarction of the spleen, and a protein S and C deficiency. In addition, blood cultures revealed a Lancefield group A ß-haemolytic streptococcus (GABHS). The patient recovered fully after treatment with low molecular weight heparin and antibiotics. CONCLUSION: In this patient, septic emboli caused splenic infarction. Thromboembolic complications should be suspected in children with VZV who present with acute symptoms, in particular if bacterial superinfection is found.
Assuntos
Varicela/complicações , Embolia/complicações , Herpesvirus Humano 3/patogenicidade , Infarto do Baço/etiologia , Infecções Estreptocócicas/complicações , Doença Aguda , Varicela/imunologia , Criança , Reações Cruzadas , Embolia/imunologia , Feminino , Humanos , Deficiência de Proteína C/etiologia , Deficiência de Proteína C/imunologia , Deficiência de Proteína C/virologia , Deficiência de Proteína S/etiologia , Deficiência de Proteína S/imunologia , Deficiência de Proteína S/virologia , Infarto do Baço/imunologia , Infarto do Baço/virologia , Infecções Estreptocócicas/imunologiaAssuntos
Isquemia Encefálica/etiologia , Doenças Arteriais Cerebrais/virologia , Herpes Zoster/complicações , Herpesvirus Humano 3/patogenicidade , Doenças Vasculares Periféricas/etiologia , Trombose/etiologia , Adulto , Síndrome Antifosfolipídica/virologia , Isquemia Encefálica/virologia , Doenças Arteriais Cerebrais/complicações , Artérias Cerebrais/virologia , Hemianopsia/etiologia , Hemiplegia/etiologia , Humanos , Masculino , Transtornos da Percepção/etiologia , Doenças Vasculares Periféricas/virologia , Deficiência de Proteína S/virologia , Oclusão da Artéria Retiniana/etiologia , Oclusão da Artéria Retiniana/virologia , Trombofilia/virologia , Trombose/virologiaRESUMO
Postinfectious purpura fulminans is a rare disease. Varicella is one of the precipitating conditions and we recently observed such a case. The 4-year-old child was found to have a severe transient protein S deficiency. By enzyme-linked immunosorbent assay and surface plasmon resonance we first demonstrated that anti-protein S antibodies were present and also transient. Next we characterized the epitopes against which these antibodies were directed and found that they predominantly recognized the N-terminal part of protein S. Finally we showed by thrombography a transient dramatic hypercoagulable state as a result of thrombin being unregulated by the dynamic protein C inhibitory system: in vitro thrombin generation, in response to a low concentration of tissue factor, was almost insensitive to activated protein C up to 25 nmol L(-1) on day 4 while it was normally sensitive on day 42. For the first time, we demonstrated a temporal relationship between protein S deficiency, antibodies to protein S and hypercoagulability, thus supporting the pathogenic role of these antibodies.