每日一题_2023.03.23

A baby girl was noted to have vesicular skin lesions immediately after spontaneous vaginal delivery at 32 weeks’ gestation. Her 37-year-old mother had premature rupture of membranes 12 days before the delivery. On physical examination, clusters of vesicles were seen on the infant’s torso (left), periumbilical region (right), and pharyngeal, nasal, and conjunctival mucosa. No lesions were seen on the mother’s genitals or the placenta. What is the most likely diagnosis?

一名女婴在妊娠32周自然阴道分娩后立即出现水疱性皮肤病变。她37岁的母亲在分娩前12天胎膜早破。体格检查时，在婴儿躯干(左)、脐周区域(右)以及咽、鼻和结膜黏膜可见成簇的水疱。母亲的生殖器或胎盘未见病变。最有可能的诊断是什么?

A. Bullous impetigo 水疱脓疱病

B. Epidermolysis bullosa 表皮松解大疱

C. Molluscum contagiosum 接触传染性软疣

D. Neonatal herpes simplex virus 新生儿单纯疱疹病毒

E. Transient pustular melanosis 暂时性脓疱性黑变病

答案解析：

正确答案是新生儿单纯疱疹病毒。对婴儿皮肤、结膜、咽部和血液样本进行的聚合酶链反应(PCR)检测显示，1型单纯疱疹病毒(HSV-1)呈阳性，并诊断为新生儿HSV-1感染，感染局限于皮肤、眼睛和黏膜。母亲自诉既往无HSV-1感染史。然而，产后宫颈内PCR检测HSV-1呈阳性。在此例中，我们认为妊娠晚期的母体原发性感染导致了宫内感染上升，并可能在胎膜长期破裂后导致早产。给予阿昔洛韦治疗。患儿2岁时无复发，发育正常。

正确答案:D