每日一题_2023.05.18

A 44-year-old man with a history of human immunodeficiency virus infection and intermittent adherence to antiretroviral therapy presented to the infectious disease clinic with a 1-month history of fevers and pruritic skin lesions. Physical examination was notable for blackish-brown lamellated plaques on the limbs and scalp. Laboratory studies were notable for a CD4 cell count of 86 per cubic millimeter (reference range, 414 to 1123) and a rapid plasmin reagin titer of 1:32. A skin biopsy of the left forearm showed diffuse dermal lymphocytes and histiocytes admixed with a plasma-cell infiltrate. What is the most likely diagnosis?

一名44岁男性有人类免疫缺陷病毒感染史，间歇性坚持抗逆转录病毒治疗，因发热和皮肤瘙痒1个月到传染病门诊就诊。体格检查发现四肢和头皮有黑褐色板层斑块。值得注意的是，实验室检查显示CD4细胞计数为86 / mm3(参考范围，414 ~ 1123 / mm3)，快速纤溶酶反应素滴度为1∶32。左前臂皮肤活检显示真皮弥漫性淋巴细胞和组织细胞混合浆细胞浸润。最有可能的诊断是什么?

A. Erythema annulare centrifugum 离心性环状红斑

B. Erythema gyratum repens 再发回状红斑

C. Erythema migrans (Lyme disease) 游走性红斑(莱姆病)

D. Lupus vulgaris (cutaneous tuberculosis) 寻常狼疮(皮肤结核)

E. Malignant syphilis 恶性梅毒

答案解析：

正确答案是恶性梅毒。梅毒螺旋体明胶凝集试验也呈阳性。恶性梅毒是一种少见的二期梅毒，主要影响免疫功能低下的人。皮肤表现多样，从溃疡结节性病变到如该患者所见的牡蛎壳样结痂。静脉滴注抗菌药物治疗2周后，皮损消退，发热消退。

正确答案：E