每日一题_2024.09.27

A 26-year-old man presented with a 1-week history of fevers and bloody stools. On physical examination, there was a small external hemorrhoid but no abdominal pain, genital lesions, or inguinal lymphadenopathy. Computed tomography of the pelvis showed thickening of the wall of the rectum (left) and perirectal lymphadenopathy. A subsequent flexible sigmoidoscopy showed nodular mucosa with erythema and ulceration in the distal rectum (right). After a tissue biopsy of the lesion, which of the following is the most appropriate next step?

一名26岁男性患者，出现一周的发热和血便症状。体格检查发现有小的外痔，但没有腹痛、生殖器病变或腹股沟淋巴结肿大。盆腔计算机断层扫描显示直肠（左侧）壁增厚和直肠周围淋巴结肿大。随后的柔性乙状结肠镜检查显示远端直肠有结节状粘膜，伴有红斑和溃疡。在对病变组织进行活检后，以下哪一步是最合适的下一步？

A. CT of the chest胸部CT

B. Rectal swab for sexually transmitted infections直肠拭子检查性传播感染

C. Fecal calprotectin粪便钙卫蛋白

D. Upper endoscopy上消化道内镜检查

E. Whole body PET-CT全身PET-CT

答案解析

活检结果未发现癌症。患者报告说，在出现症状前3周，他与一位新的男性伴侣发生了未使用避孕套的接受性肛交。在直肠拭子上进行的核酸扩增检测显示沙眼衣原体阳性，而L血清型检测阴性（表明这不是性病淋巴肉芽肿）。其他性传播感染的检测发现人类免疫缺陷病毒阳性，CD4细胞计数为每立方毫米551个（参考范围，560至1840），病毒载量为每毫升129,000拷贝（检测下限，20）。开始使用多西环素和抗逆转录病毒药物治疗。五天后，直肠症状已经解决。

正确答案：B