Concordância entre diagnósticos neuropatológicos premortem e postmortem em 90 pacientes com síndrome da imunodeficiência adquirida, submetidos à necrópsia em um hospital de ensino no Brasil / Agreement between premortem e postmortem neuropathological diagnoses in 90 patients with acquired immune deficiency syndrome, submitted to autopsy at a teaching hospital in Brazil

RESUMO

Objetivo: Estudar as lesões anatomopatológicas no SNC, analisando se contribuíram para o óbito des s es pacientes e avaliar a concordância entr e os diagnósticos neuropatológ icos premortem e postmortem. Método: Estudo retrospectivo com análise de 90 necrópsias sequenciais de SIDA, realizadas entre 1989 e 1996, além de busca de dados epidemiológicos/clínicos e comparação com a suspeita clínica para avaliar concordância entre diagnóstico pre e postmortem. Resultados: Idade média 34 ± 11 anos; 81,1% do sexo masculino; todos apresentavam alguma alteração no SNC, sendo relevantes para o óbito em 54 (60%) casos. Apenas em 15 (27,8%) desses 54 casos houve s uspeita clínica da le s ão. As lesões encontr adas no SNC for am: toxoplasmos e (34,4%), c r i ptococo s e (12,2%), c itomega lovi r o s e (4,4%), encefa lite nodul a r m ic r og li a l (3,3%), mening ite bacter iana (2,2%), infecção pelo vír us JC (2,2%), tuberculos e/micobacter ios e (2,2%), histoplasmose (1,1%) e paracoccidioidomicose (1,1%). As alterações não relacionadas ao óbito (40%) for am: g lios e, fibros e meníngea focal, infar to antigo, calcificações e edema . Este estudo confirma que existem diversas alterações no SNC de pacientes com SIDA, sobretudo infecções oportunistas, frequentemente não suspeitadas clinicamente, evidenciando a importância da necrópsia. Esses achados sugerem que investigação minuciosa deveria ser feita no SNC de pacientes com SIDA, particularmente naqueles com diagnóstico tardio ou que não estão respondendo ao tratamento.

ABSTRACT

Agreement between premortem e postmortem neuropathological diagnoses in 90 patients with acquired immune deficiency syndrome, submitted to autopsy at a teaching hospital in Brazil. Objective: The aim was to study the anatomopathological lesions in CNS, analyzing if they have contributed to the death of those patients, and to evaluate the agreement between premortem and postmortem neuropathological diagnoses. Method: Retrospective study on 90 necropsies on patients with AIDS, performed between 1989 and 1996, besides having been performed the search for clinical and epidemiologycals datas, was done a comparison with the clinical suspicion, to analyze the concordance between premortem and postmortem diagnoses. Results: The patients? mean age was 34 ± 11 years, 81.1% were male. CNS lesions were found in all of the cases. In 54 (60%) cases, CNS lesions of relevance to the death were found, but there had only been clinical suspicion of such lesions in 15 (27.8%) of them. The lesions consisted of toxoplasmosis (34.4%), cryptococcosis (12.2%), cytomegalovirosis (4.4%), microglial nodular encephalitis (3.3%), bacterial meningitis (2.2%), JC virus infection (2.2%), tuberculosis/mycobacteriosis (2.2%), histoplasmosis (1.1%) and paracoccidioidomycosis (1.1%). The unrelated lesions with the death (40%) were: gliosis, meningeal fibrosis, old infarct, calcifications and edema. Conclusion: This study confirms that several changes occurred in the CNS of patients with AIDS, especially opportunistic infections, that frequently are not suspected clinically. These findings suggest that detailed investigation should be conducted on CNS of patients with AIDS, particularly those who are not responding to treatment or with late diagnoses.