每日一题_2023.10.20

An 8-year-old girl was brought to the dermatology clinic with a 3-day history of painful lip crusting, oral ulcers, rash, and genital pain. Ten days before presentation, a fever and cough had developed. She had no history of medication use. Physical examination was notable for conjunctivitis in both eyes and ulcers in the oropharynx. There were scattered vesicular lesions across her face, and her swollen, bleeding, exudative lips made it difficult for her to open her mouth (left). Targetoid lesions with vesicles were scattered across her arms and legs (right), and multiple small ulcers were found in the vulvar and perianal regions. Rales were present in both lung bases. Imaging of the chest showed infiltrates in both lungs. What is the most appropriate next step?

患者女，8岁，因唇结痂、口腔溃疡、皮疹、生殖器疼痛3 d就诊于皮肤科。就诊前10日，患者出现发热和咳嗽。患者无用药史。体格检查发现双眼结膜炎和口咽部溃疡。她的面部有散在的水疱性病变，她肿胀、出血、渗出的嘴唇使她难以张口(左)。四肢散在靶样病灶伴水疱(右)，外阴及肛周多发小溃疡。双肺基底部均有啰音。胸部影像学显示双肺浸润。下一步最合适的是什么?

A. Administration of systemic glucocorticoids 给予全身性糖皮质激素

B. Allergy/immunology consultation 过敏/免疫学会诊

C. Skin biopsy 皮肤活检

D. Testing for bacterial and viral respiratory pathogens 细菌和病毒呼吸道病原体检测

E. Testing for herpes simplex virus单纯疱疹病毒检测

答案解析：

肺炎支原体的血清IgM抗体检测和痰聚合酶链反应检测结果呈阳性。诊断为支原体引起的皮疹和黏膜炎。虽然这种感染后皮肤黏膜综合征的表现方式可能与Stevens-Johnson综合征相似，但预后较好。给予支持性治疗，并给予多西环素治疗肺炎。2周后，病变减轻，肺炎症状很快消退。

正确答案：D