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NEJM：红斑的基础上丛生的脓疱是啥？-案例报道

2017-03-09 xing.T MedSci原创

红斑的基础上丛生的脓疱单纯疱疹病毒水痘带状疱疹病毒
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在红色基底上丛生的、融合的脓疱或水疱形态学特征是疱疹病毒感染的特点。Tzanck涂片检查提供了一种快速诊断单纯疱疹病毒感染和水痘带状疱疹病毒感染的方法。

患者为一名27岁女性，既往有生殖器疱疹病史，因其左臂出现疼痛、烧灼样病变而到急诊就诊。

体格检查发现患者左臂上有集群的、融合的脓疱，在红斑的基础上有扇形边界，触诊伴有压痛（如图A所示）。其中一个脓疱是无顶冠的（即移除脓疱顶部），并且挠刮基底部，涂抹到玻片上，用Wright-Giemsa染色（Tzanck涂片）。显微镜检查发现大量的多核巨细胞，并有成形的细胞核和边缘染色质（如图B所示），这表明为人类疱疹病毒感染。聚合酶链反应检测证实为存在2型单纯疱疹病毒。




在红色基底上丛生的、融合的脓疱或水疱形态学特征是疱疹病毒感染的特点。Tzanck涂片检查提供了一种快速诊断单纯疱疹病毒感染和水痘带状疱疹病毒感染的方法。

该患者在给予剂量为1000mg每日两次的伐昔洛韦治疗7天后，患者的症状和体征完全缓解。

原始出处：

Michael A. Cardis,et al. Grouped Pustules on an Erythematous Base, N Engl J Med 2017; 376:971March 9, 2017DOI: 10.1056/NEJMicm1609042

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  1. [GetPortalCommentsPageByObjectIdResponse(id=180476, encodeId=98a71804e6ba, content=观察细致！, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Fri Mar 17 01:09:14 CST 2017, time=2017-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1436091, encodeId=3830143609120, content=<a href='/topic/show?id=22f8e71238d' target=_blank style='color:#2F92EE;'>#红斑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77123, encryptionId=22f8e71238d, topicName=红斑)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Mar 11 00:19:00 CST 2017, time=2017-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178807, encodeId=812e1e880769, content=这个部位出现不常见, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Fri Mar 10 07:44:54 CST 2017, time=2017-03-10, status=1, ipAttribution=)]
    2017-03-17 laoli

    观察细致！

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=180476, encodeId=98a71804e6ba, content=观察细致！, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Fri Mar 17 01:09:14 CST 2017, time=2017-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1436091, encodeId=3830143609120, content=<a href='/topic/show?id=22f8e71238d' target=_blank style='color:#2F92EE;'>#红斑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77123, encryptionId=22f8e71238d, topicName=红斑)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Mar 11 00:19:00 CST 2017, time=2017-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178807, encodeId=812e1e880769, content=这个部位出现不常见, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Fri Mar 10 07:44:54 CST 2017, time=2017-03-10, status=1, ipAttribution=)]
    2017-03-11 zhouqu_8

    #红斑#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=180476, encodeId=98a71804e6ba, content=观察细致！, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLC1BMzZWdMSPQWuib6BtQGicK8ygGBM6YakpfkRc67soFSuKbZr86enL1KggQZEZbgWSeicJibafmYfQ3AibicIHMwwicmDShfRFvvI38/0, createdBy=272a110164, createdName=laoli, createdTime=Fri Mar 17 01:09:14 CST 2017, time=2017-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1436091, encodeId=3830143609120, content=<a href='/topic/show?id=22f8e71238d' target=_blank style='color:#2F92EE;'>#红斑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77123, encryptionId=22f8e71238d, topicName=红斑)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Mar 11 00:19:00 CST 2017, time=2017-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=178807, encodeId=812e1e880769, content=这个部位出现不常见, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=48ce1618316, createdName=stupidox, createdTime=Fri Mar 10 07:44:54 CST 2017, time=2017-03-10, status=1, ipAttribution=)]
    2017-03-10 stupidox

    这个部位出现不常见

    0