10例恶性梅毒合并HIV感染患者临床特征并文献复习  

Analysis of Clinical Features of Ten HIV-infected Patients with Malignant Syphilis and with Literature review

作　　者：刘静[1] 赵兴云[1] 袁柳凤[1] 庞艳华 魏春波[1] 闫会文[1] 孙磊[1] 吴焱[1] 伦文辉[1] LIU Jing;ZHAO Xingyun;YUAN Liufeng;PANG Yanhua;WEI Chunbo;YAN Huiwen;SUN Lei;WU Yan;LUN Wenhui(Beijing Ditian Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院,北京100015

出　　处：《中国艾滋病性病》2021年第9期1012-1016,共5页Chinese Journal of Aids & STD

基　　金：北京市医院管理中心“青苗”计划专项经费资助(QML20201803)。

摘　　要：目的对恶性梅毒(MS)病例的临床、血清学和组织病理学特点、治疗与预后等进行总结,为MS诊疗提供依据。方法收集在北京地坛医院就诊的10例MS患者的一般资料、临床表现、血液学检查特点、组织病理学、治疗及转归情况,对收集资料进行分析。结果 10例患者均为HIV抗体阳性的MSM,年龄在23~41岁,病程在3周到4个月之间;其最常见的表现是多部位的溃疡性斑块结节,中央附着蛎壳样结痂,可累及面部、躯干和四肢。实验室检查示TRUST滴度均≥1∶32,CD4细胞平均(332±240)个/μL。9例患者进行了苄星青霉素G治疗,1例患者进行了头孢曲松治疗,所有患者在抗生素治疗后皮疹很快消退。所有患者均接受了预防性糖皮质激素治疗,没有出现吉海反应。结论患者尤其是年轻的HIV阳性的MSM,出现结节坏死性皮损时,皮肤科医生应该警惕MS,及早行血液学的辅助检查,以便早诊断和治疗,驱梅治疗后预后较好。Objective Malignant syphilis(MS) is a rare ulcerative variety of secondary syphilis.To describe individuals with MS and associated risk factors and prognosis,10 cases diagnosed in our hospital from June 2014 to March 2019 were summarized.Methods We analyzed general information,clinical,serologic,and histopathologic characteristics of MS and explored its response to treatment and association with HIV infection.Results All 10 cases occurred in HIV-positive individuals aged 23-41 years old and with the course of 3 weeks to 4 months.The most frequent manifestation of MS was ulceronodular cutaneous lesions with central adherent crust,which affected the face,trunk,and limbs.Laboratory tests showed that the TRUST titer was≥1:32,and a CD4 cell count in the 44-864 cells/μL range.Nine patients were treated with benzathine penicillin G and one case was treated with ceftriaxone.All the patients experienced a rapid clinical improvement following the antibiotic therapy.All of them had been given prophylactic corticosteroids but Jarisch-Herxheimer’s reaction was not reported.Conclusions Dermatologists should be vigilant to MS in the differential diagnosis of young HIV-positive patients with ulcerated,necrotic lesions.Early auxiliary examinations of serology are essential for the earlier diagnosis and treatment of this disease.The overall prognosis is good.

关 键 词：恶性梅毒 二期梅毒 艾滋病病毒 

分 类 号：R373.9[医药卫生—病原生物学] R759[医药卫生—基础医学]