每日一题_2024.02.29

A 40-year-old man was referred to the otorhinolaryngology clinic with a 1-month history of a sore throat. He reported no upper respiratory symptoms, fever, rash, or genital lesions. The physical examination was notable for nonulcerated white plaques that formed a butterfly shape across the posterior oropharynx, upper uvula, and tonsils. No lymphadenopathy or skin or genital lesions were present. Testing for the human immunodeficiency virus was negative. A biopsy of the plaques showed dense lymphoplasmacytic infiltration. Which of the following tests is most likely to reveal the diagnosis?

一名40岁男性因咽喉痛1个月被转诊至耳鼻喉科门诊。患者自诉无上呼吸道症状、发热、皮疹或生殖器病变。体格检查发现无溃疡的白色斑块，在后口咽、上悬垂和扁桃体形成蝴蝶状。无淋巴结肿大或皮肤或生殖器病变。人类免疫缺陷病毒检测结果为阴性。斑块活检显示密集的淋巴浆细胞浸润。下列哪项检查最有可能揭示诊断?

A. Congo red stain of the biopsy specimen 活检标本的刚果红染色

B. Flow cytometry of the biopsy specimen 活检标本的流式细胞术

C. Grocott’s methenamine silver stain of the biopsy specimen Grocott的六胺银染色活检标本

D. Serum protein electrophoresis 血清蛋白电泳

E. Treponema pallidum hemagglutination assay 梅毒螺旋体血凝试验

答案解析：

梅毒螺旋体血凝试验呈阳性，快速血浆反应素水平为122.4 U(参考范围，0 ~ 0.9)。随后对活检标本进行的梅毒螺旋体免疫组织化学染色呈阳性。诊断为梅毒性咽炎(二期梅毒的表现)。由于缺乏苄星青霉素G，按照当地指南给予了阿莫西林治疗。治疗开始后1个月随访时，患者症状减轻。

正确答案：E