每日一题_2024.10.04

A 25-year-old woman with systemic lupus erythematosus (SLE) presented with a 3-month history of a rash on her arms, legs, and groin. She had been having condomless sexual intercourse with one male partner during the year preceding presentation. During the 9 months before presentation, she had been taking hydroxychloroquine at a dose of 200 mg daily and prednisolone at a dose of 15 to 40 mg daily to control her SLE. Physical examination was notable for erosive, violaceous plaques in the antecubital fossae, popliteal fossae, and inguinal regions. There were also scaly erythematous patches on both palms. What is the most likely diagnosis?

一位25岁的女性，患有系统性红斑狼疮（SLE），她有3个月的手臂、腿部和腹股沟皮疹病史。在出现症状的前一年，她与一名男性伴侣进行了无保护性行为。在出现症状前的9个月里，她一直在服用每日200毫克的羟氯喹和每日15至40毫克的强的松龙来控制她的SLE。体格检查显示，在肘前窝、腘窝和腹股沟区域有侵蚀性、紫罗兰色的斑块。在双手掌上也有鳞屑性红斑。最可能的诊断是什么？

A. Discoid lupus盘状狼疮

B. Extramammary Paget disease非乳腺Paget病

C. Pemphigus vulgaris寻常性天疱疮

D. Symmetric drug-related intertriginous and flexural exanthema对称性药物相关间擦疹和屈侧疹

E. Syphilis梅毒

答案解析：

梅毒螺旋体血凝试验呈阳性，快速血浆反应素（RPR）滴度为1:128。右腹股沟皱襞的皮肤活检样本的免疫组织化学染色对梅毒螺旋体呈阳性。诊断为伴有间擦疹的二期梅毒。在免疫抑制的患者中，二期梅毒的皮疹可能非常多变且不典型。

正确答案：E