An autopsy case of cerebral hemorrhage in an HIV-infected patient with suspected HIV-associated cerebrovascular disease

IF 1.2 4区 医学 Q3 MEDICINE, LEGAL
Mio Takayama, Masayuki Kashiwagi, Aya Matsusue, Brian Waters, Shin-ichi Kubo
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Abstract

A male in his late 30s was found dead in his home. He was diagnosed with human immunodeficiency virus (HIV) about six years prior. The HIV infection was well controlled before his death. He was 166 cm in height and 75 kg in weight. Aside from discoloration of the skin on the right lower patellar, there were no obvious injuries. His brain weighed 1456 g. A cut surface of the brain revealed left thalamic hemorrhage. Histologically, infiltration of phagocytic cells was observed in the bleeding site. Thalamic hemorrhage was considered to be his cause of death in this case. Due to the effects of anti-HIV therapy, the mortality rate from HIV infection has decreased and the causes of death of HIV-infected persons have changed. HIV-infected persons have been suggested to be associated with cerebrovascular disease, especially juvenile ischemic stroke. Patients with acquired immunodeficiency syndrome (AIDS) have an increased risk of cerebrovascular disease. Possible mechanisms of cerebrovascular disease in HIV-infected individuals include coagulopathy, secondary effects of embolism and central nervous system infection, and direct vascular disease due to HIV. At the time of autopsy, his post-mortem interval was estimated to be approximately two weeks. Therefore, it was difficult to clarify histologically the cerebrovascular disorder that caused his cerebral hemorrhage. In recent years, anti-HIV therapy has reduced the number of AIDS-related deaths, but deaths in HIV-infected people from cardiovascular disease are increasing. This case is considered to be a valuable forensic autopsy case of an HIV-infected patient who actually died due to cerebral hemorrhage in Japan.

一名疑似艾滋病毒相关性脑血管病艾滋病毒感染者脑出血的尸检病例
一名 30 多岁的男性被发现死于家中。大约六年前,他被诊断出感染了人体免疫缺陷病毒(HIV)。死前艾滋病毒感染得到了很好的控制。他身高 166 厘米,体重 75 公斤。除了右下髌骨皮肤变色外,没有明显外伤。大脑切面显示左侧丘脑出血。组织学上观察到出血部位有吞噬细胞浸润。在这个病例中,丘脑出血被认为是他的死因。由于抗艾滋病病毒疗法的效果,艾滋病病毒感染者的死亡率有所下降,艾滋病病毒感染者的死因也发生了变化。艾滋病病毒感染者被认为与脑血管疾病有关,尤其是青少年缺血性中风。获得性免疫缺陷综合征(艾滋病)患者罹患脑血管疾病的风险增加。艾滋病病毒感染者脑血管疾病的可能机制包括凝血功能障碍、栓塞和中枢神经系统感染的继发效应以及艾滋病病毒导致的直接血管疾病。尸检时,他的死后间隔估计约为两周。因此,很难从组织学角度明确导致其脑出血的脑血管疾病。近年来,抗艾滋病毒治疗减少了艾滋病相关死亡人数,但艾滋病毒感染者死于心血管疾病的人数却在增加。本病例被认为是日本因脑出血而死亡的 HIV 感染者的珍贵法医尸检病例。
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来源期刊
CiteScore
2.70
自引率
6.70%
发文量
106
审稿时长
57 days
期刊介绍: The Journal of Forensic and Legal Medicine publishes topical articles on aspects of forensic and legal medicine. Specifically the Journal supports research that explores the medical principles of care and forensic assessment of individuals, whether adult or child, in contact with the judicial system. It is a fully peer-review hybrid journal with a broad international perspective. The Journal accepts submissions of original research, review articles, and pertinent case studies, editorials, and commentaries in relevant areas of Forensic and Legal Medicine, Context of Practice, and Education and Training. The Journal adheres to strict publication ethical guidelines, and actively supports a culture of inclusive and representative publication.
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