RESUMEN
Central diabetes insipidus (DI) was detected in a patient with hemorrhagic fever with renal syndrome (HFRS) who had been molecularly and serologically diagnosed with Hantaan virus infection. We recommend that clinicians differentiate central DI in HFRS patients with a persistent diuretic phase even when pituitary MRI findings are normal.
Asunto(s)
Diabetes Insípida Neurogénica/fisiopatología , Virus Hantaan/genética , Fiebre Hemorrágica con Síndrome Renal/fisiopatología , Hipopituitarismo/fisiopatología , Desamino Arginina Vasopresina/uso terapéutico , Diabetes Insípida Neurogénica/diagnóstico por imagen , Diabetes Insípida Neurogénica/metabolismo , Diabetes Insípida Neurogénica/virología , Virus Hantaan/clasificación , Virus Hantaan/aislamiento & purificación , Fiebre Hemorrágica con Síndrome Renal/diagnóstico por imagen , Fiebre Hemorrágica con Síndrome Renal/metabolismo , Fiebre Hemorrágica con Síndrome Renal/virología , Humanos , Hipopituitarismo/diagnóstico por imagen , Hipopituitarismo/metabolismo , Hipopituitarismo/virología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Filogenia , Tiroxina/uso terapéuticoRESUMEN
We report a case of central diabetes insipidus (CDI) in a patient with AIDS due to cytomegalovirus (CMV) infection of the vasopressin-producing areas of the hypothalamus. The clinical diagnosis is established by definitive clinical and laboratory evidence of CDI. Detailed histopathological and immunohistochemical studies establish CMV as the causative agent and demonstrate the deficit of vasopressin in the synthesizing neurons. Physicians caring for patients with AIDS should be aware of CDI and adipsic hypernatremia as potential complications of CMV infection. The case also demonstrates that patients with diabetes insipidus do not have polyuria when glucocorticoid deficiency coexists.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones por Citomegalovirus/complicaciones , Diabetes Insípida Neurogénica/virología , Hipotálamo/virología , Adulto , Diabetes Insípida Neurogénica/metabolismo , Diabetes Insípida Neurogénica/patología , Diabetes Insípida Neurogénica/fisiopatología , Resultado Fatal , Humanos , Hipotálamo/metabolismo , Inmunohistoquímica , Masculino , Vasopresinas/deficienciaRESUMEN
OBJECTIVE: To describe a patient immunocompromised by Cushing's syndrome in whom central diabetes insipidus developed as a complication of herpes simplex involvement of the hypothalamus. METHODS: We present a case, including results of laboratory and histopathologic studies, in which herpes simplex was established as the causative agent for central diabetes insipidus. RESULTS: A woman with ectopic corticotropin-dependent Cushing's syndrome, diabetes mellitus, carcinoid tumor, and a history of thyroid cancer had the precipitous onset of seizure and fever, and hypotonic polyuria and progressive hypernatremia developed. Central diabetes insipidus was diagnosed and successfully treated with desmopressin. Nevertheless, the patient's condition deteriorated and she died. Autopsy revealed herpes simplex encephalitis involving the magnicellular neurons of the hypothalamus. CONCLUSION: Central diabetes insipidus caused by viral infections has been reported in immunosuppressed patients, such as those with acquired immunodeficiency syndrome (AIDS). To our knowledge, this is the first report of a herpes infection causing diabetes insipidus in a patient immunosuppressed by Cushing's syndrome. This case demonstrates that, in patients with Cushing's syndrome, diabetes insipidus may develop as a result of herpes simplex infection of the hypothalamus.