每日一题_2025.01.30

A 29-year-old man with well-controlled human immunodeficiency virus infection presented with a 1-week history of a painful, whitish discoloration on his tongue. He also reported a 4-week history of painful ulcers on the scrotum. Physical examination showed smooth, pink, guttate macules on the tongue that were within a white coating that did not wipe off. No rash, ulcer, or lymphadenopathy was seen on genital examination; the reported lesions were presumed to have already resolved. Which of the following is the most likely cause of this patient’s tongue changes?

一名29岁男性，人类免疫缺陷病毒感染控制良好，主诉舌头上出现疼痛的白色变色已有一周。他还报告了阴囊上疼痛性溃疡已有四周。体格检查显示舌头上有多处光滑、粉红色、点滴状的斑块，这些斑块位于无法擦去的白色涂层内。生殖器检查未见皮疹、溃疡或淋巴结肿大；报告的病变被认为已经消退。以下哪项最可能是该患者舌头变化的原因？

A. Geographic tongue地图舌

B. Lichen Planus扁平苔藓

C. Oral leukoplakia口腔白斑

D. Secondary syphilis二期梅毒

E. Squamous Cell Carcinoma 鳞状细胞癌

答案解析：

就诊当天的实验室检查结果显示，血清快速血浆反应素滴度为1:32，梅毒螺旋体颗粒凝集试验阳性。诊断为二期梅毒的“割草样”舌部病变（法语：plaques en prairie fauchée）。二期梅毒的“割草样”舌部病变是指舌后部白色涂层内出现脱乳头状的黏膜斑块。患者接受了单剂苄星青霉素G治疗，七天后病变完全消退。

正确答案：D