每日一题_20240704

A 29-year-old man presented to the outpatient clinic with 2 months of bright red blood from the rectum. He had no fever, weight loss, diarrhea, or hematuria. He lived in the interior of northeastern Brazil and regularly bathed in rivers. On physical examination, he had slight tenderness to palpation of the left flank. Laboratory testing was notable for an absolute eosinophil count of 470 per cubic millimeter (reference range, 34 to 420). A colonoscopy identified a reddish, polypoid lesion in the distal rectum. Biopsy of the lesion revealed a dense inflammatory infiltrate containing eosinophils and schistosome eggs. What is the appropriate treatment for this condition?

一名29岁男子因2个月的直肠鲜红色血液来到门诊。他没有发烧、体重减轻、腹泻或血尿。他住在巴西东北部内陆，经常在河里洗澡。体格检查时，他的左侧触诊有轻微压痛。实验室检测显示绝对嗜酸性粒细胞计数为470 /立方毫米(参考范围为34 ~ 420)。结肠镜检查发现直肠远端有一红色息肉样病变。病变活检显示密集炎性浸润，含嗜酸性粒细胞和血吸虫卵。这种情况的适当治疗是什么?

A. Itraconazole 伊曲康唑

B. Ivermectin 伊维菌素

C. Metronidazole 灭滴灵

D. Nitazoxanide 硝唑尼特

E. Praziquantel 吡喹酮

答案解析：

诊断为慢性直肠血吸虫病。当血吸虫卵沉积在胃肠道粘膜下层时，宿主的炎症反应引起异物反应。随后的纤维化和炎症导致息肉样病变的形成，可溃烂和出血，如本例所示。给予吡喹酮治疗。治疗一个月后，患者不再出血。随访6个月结肠镜检查显示息肉样病变消失。

正确答案：E