A 42-year-old man with human immunodeficiency virus (HIV) infection presented with painful skin ulcerations（溃疡） and systemic symptoms. Physical exam showed large ulcers with overlying keratosis（角化） and crusting scattered across his scalp, face, perineum, and limbs. Laboratory studies showed a CD4 count of 399 cells/mm3. Skin biopsy showed superficial dermal infiltration of lymphocytes, histiocytes, and plasma cells in a lichenoid pattern with psoriasiform epidermal hyperplasia.
What is the most likely diagnosis?
A. Bacillary angiomatosis
B. Disseminated histoplasmosis
C. Lupus vulgaris (tuberculosis luposa)
D. Malignant syphilis
E. Norwegian scabies
答案解析：
免疫组织化学分析显示存在螺旋体。 快速纤溶酶反应素滴度为 1:512。 患者被诊断为恶性梅毒，这是一种不常见的二期梅毒，其特征是全身症状和丘疹脓疱疹，然后演变成疼痛的坏死性溃疡。 静脉注射青霉素 G 后患者症状减轻。
正确答案：D
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