每日一题_2023.06.23

A 39-year-old man with human immunodeficiency virus infection that was being treated with antiretroviral therapy presented to the dermatology clinic with a 1-year history of recurrent, painful penile ulcers. Approximately once per month, erosions would appear ulcerate, heal spontaneously and then recur. Laboratory testing showed a CD4 cell count of 494 per cubic millimeter (reference range, 414 to 1123) and an HIV viral load of 450 copies per milliliter (reference range, <20). Biopsies of the lesions revealed epidermal necrosis, pseudoepitheliomatous epidermal hyperplasia, and a dense infiltrate of inflammatory cells in the dermis and subcutaneous tissue. Next-generation sequencing (NGS) of the tissue was performed. What is the most likely diagnosis?

一名正在接受抗逆转录病毒治疗的39岁人类免疫缺陷病毒感染男性到皮肤科诊所就诊，他有1年的复发性、疼痛性阴茎溃疡病史。大约每个月一次，糜烂会出现溃疡，自愈，然后复发。实验室检测显示CD4细胞计数为494 / mm3(参考范围，414 ~ 1123)，HIV病毒载量为450拷贝/ ml(参考范围，&lt;20)。皮损组织活检示表皮坏死、假上皮瘤样表皮增生，真皮及皮下组织炎性细胞密集浸润。对组织进行二代测序(NGS)。最有可能的诊断是什么?

A. Chancroid 软性下疳

B. Condyloma acuminata 尖锐湿疣

C. Condyloma lata 湿疣

D. Herpes vegetans 增殖性天疱疮

E. Pemphigus vegetans 增生型天疱疮

答案解析：

正确答案是Herpes vegetans。二代测序检测出单纯疱疹病毒(HSV)- 2。Herpes vegetans(又称肥大性单纯疱疹)是单纯疱疹病毒感染的一种罕见表现，见于免疫功能低下的人。表现为疣状、增生性或溃疡性病变，常为慢性、持续性病程。给予伐昔洛韦口服治疗，随访2周，皮损减轻。

正确答案：D