二期梅毒伴肝肾损害2例及文献复习  

Simultaneous Hepatic and Renal Involvement in Secondary Syphilis.Report of 2 Cases and Review of the Literatures

作　　者：王红枫[1] 干慧慧[1] 梅莉红[1] 曾义斌[1] 权哲[1] 方芳[1] 

机构地区：[1]复旦大学附属金山医院皮肤科,上海201508

出　　处：《中国皮肤性病学杂志》2015年第6期603-605,共3页The Chinese Journal of Dermatovenereology

摘　　要：例1男,31岁。包皮破溃1个月,下肢水肿1周。包皮、阴囊见散发红斑,掌跖、双腕鳞屑性铜红色斑,眼睑及双下肢水肿。TRUST 1:128(+),梅毒螺旋体特异抗体(+)。尿蛋白(3+),24h尿蛋白定量24g/d,肝功能碱性磷酸酶(ALP)367IU/L,白蛋白15g/L。例2男,63岁。双下肢水肿伴腹胀1周。双大腿、包皮、龟头见散发鳞屑性红斑丘疹,阴囊皮肤散发结痂面,双足底隐约见散发暗红斑,双下肢水肿。TRUST 1:512(+),梅毒螺旋体特异抗体(+)。尿蛋白(3+),24h尿蛋白定量26.6g/d,ALP351u/L,白蛋白22g/L。肾穿刺活检示膜性肾病。该2例均予头孢曲松1g肌注,1次/d,连用10d后临床表现、生化指标均迅速恢复正常,梅毒血清抗体滴度下降,支持梅毒是急性肝肾病变的病因。Case 1 ： a 31-year-old male presented with ulceration in the foreskin for one month and edema of lower ex- tremities for one week. Scattered red maculopapules were on the foreskin and scrotum, and copper red mac- ules with scales presented on the palms, soles and wrists. There was marked edema over both legs and peri- orbital areas. TRUST titre was 1：128, and blood specific Treponema pallidum antibody test was positive. U- rine protein test was 3 ＋. The 24-hour urine protein content was 2gg. Blood tests showed a higher ALP level （367IU/L） and a lower albumin level （15 g/L）. Case 2： a 63-year-old male presented with edema on both legs and abdominal distension for one week. Scattered red maculopapules with scales presented on the thighs, foreskin and the glans penis in addition to crusts on the scrotum. Scattered dark red macules were found on both soles. There was marked edema on the legs. TRUST titre was 1：512, and blood specific Trep- onema pallidum antibody test was positive. Urine protein test was 3 ＋. The 24-hour urine protein content was 26.6g. Blood tests revealed a higher level of ALP （351IU/L） and lower albumin level （22 g/L）. Re- nal needle biopsy showed membranous nephropathy （stage I）. Following intramuscularly given eeftriaxone （lg） once daily for 10 days, clinical manifestations and biochemical abnormalities disappeared in both patients along with the reduction of serum syphilis antibody titer, supporting that both acute hepatic and renal diseases were caused by Syphilis.

关 键 词：梅毒 肾病 肝炎 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]