每日一题_2024.08.30

A 9-year-old girl presented to the dermatology department with a 7-day history of a lesion on the left cheek and a 4-day history of fever. On physical examination, a round plaque 3 cm in diameter on an erythematous base was observed on the patient’s left cheek, with overlying crusting and a single intact vesicle. Satellite vesicles and ipsilateral cervical lymphadenopathy were also present. There were no mucosal lesions. What is the most likely diagnosis?

一名9岁女孩因左脸颊病变7天及发热4天就诊于皮肤科。体格检查时，在患者左脸颊红斑基部观察到一个直径3厘米的圆形斑块，上面有硬壳和一个完整的小泡。卫星囊泡和同侧颈淋巴肿大也存在。未见粘膜病变。最可能的诊断是什么?

A. Cutaneous non-tuberculous mycobacterial infection

B. Impetigo脓疱病

C. Primary cutaneous HSV-1 infection原发性皮肤HSV-1感染

D. Syphilitic chancre梅毒下疳

E. Tinea corporis体藓

答案解析：

患者的父亲在10天前开始出现下唇结痂，与唇疱疹愈合一致。聚合酶链反应测定患者脸颊上的无顶囊泡呈1型单纯疱疹病毒(HSV-1)阳性。1型单纯疱疹病毒通过直接接触疱疹性病灶或受感染的粘膜分泌物传播。在这个案件中，没有对性虐待的担忧。当1型单纯疱疹病毒感染在儿童中表现为皮肤病变而不累及粘膜时，它可能与脓疱疮的蜂蜜外壳外观混淆。

正确答案：C