二期梅毒误诊为荨麻疹性血管炎1 例

2019-08-29 白瑶 石春蕊 刘昱彤 中国皮肤性病学杂志

患者女, 20 岁,全身出现水肿性红斑伴痒 10 d, 加重4 d。10 d 前无明显诱因患者左手腕部出现水 肿性红斑伴瘙痒,未予重视,自行口服扑尔敏、氯雷 他定、维生素 C 及外用炉甘石洗剂治疗,疗效欠佳, 皮损未消退,继而泛发全身,且数目逐渐增多,伴轻 度瘙痒。患者发病前无用药史;既往体健,无输血史 及外伤史,无药物、食物、花粉过敏史,家族史无特殊疾病,否认硬下疳、性病、冶游史,学生,未婚。体

1 临床资料

患者女, 20 岁,全身出现水肿性红斑伴痒 10 d, 加重4 d。10 d 前无明显诱因患者左手腕部出现水 肿性红斑伴瘙痒,未予重视,自行口服扑尔敏、氯雷 他定、维生素 C 及外用炉甘石洗剂治疗,疗效欠佳, 皮损未消退,继而泛发全身,且数目逐渐增多,伴轻 度瘙痒。患者发病前无用药史;既往体健,无输血史 及外伤史,无药物、食物、花粉过敏史,家族史无特殊疾病,否认硬下疳、性病、冶游史,学生,未婚。体检: 一般情况良好,系统检查未见明显异常。皮肤科情 况:左腋下、双手背及双足背可见散在分布的数个大 小不等形态不规则的水肿性红斑,其间见少许片状 色素沉着斑,掌跖部位未见皮损,左腕部可见一直径 约5 cm 环状水肿性红斑,左踝关节伸侧可见一大小 约5 cm ×3 cm 环状水肿性红斑( 图 1) 。肛门及会 阴部未见糜烂、溃疡; 口腔内未见损害; 未见脱发。拟诊“荨麻疹性血管炎”。实验室检查: 血清梅毒血 凝集试验( TPPA) ( + ) ,快速血浆反应素实验 ( RPR)( +) 1∶ 32;血 WBC 15. 07 ×109 /L, RBC 3. 99 ×1012 /L, Pt 331 ×109 /L, Hb 114 g/L; 尿常规、粪常 规、生化全项、胸片、腹部 B 超、自身抗体及免疫球 蛋白、 C3 和 C4 补体等辅助检查未见明显异常; HIV 筛查( - ) 。皮损组织病理( 右踝关节) 示: 角化过度,上皮突存在,棘层增厚,基底膜完整,真皮浅层及 小血管周围可见淋巴细胞及浆细胞浸润( 图2) 。再 次追问病史,其2 个月前有明确的无安全措施性接 触史, 1 个月前出现无痛性右侧腹股沟淋巴结肿大, 无会阴处糜烂及溃疡, T 40 ℃,自服“头孢类”抗生 素后好转。诊断: 二期梅毒,予苄星青霉素 240 万 U,连用3 周,皮损消退。患者目前在随访中。



图1 双手足可见( ) 散在分布的数个大小不等形态不规则的水肿性红斑,部分皮损消退后遗留色素沉着,左腕部( ) 可见 一直径约5 cm 环状水肿性红斑,左踝关节伸侧( ) 可见一大小约 5 cm ×3 cm 环状水肿性红斑; 图 2a ~2b 右踝关节 皮损组织病理示:角化过度,上皮突存在,棘层肥厚,基底膜完整,真皮浅层及小血管周围可见淋巴细胞及浆细胞浸润

2 讨论

梅毒是由梅毒螺旋体引起的一种常见的慢性传 染病,主要通过性接触传播。一期梅毒主要表现为 硬下疳和硬化性淋巴结炎,一般无全身症状。一期 梅毒若未经治疗或治疗不彻底,梅毒螺旋体可由淋 巴系统进入血液循环形成菌血症继而播散全身,形 成二期梅毒,表现为皮肤黏膜及系统性损害[1]。皮 损主要表现为斑疹性、斑丘疹性、丘疹性,以湿疹、皮 炎、银屑病、斑块型为表现的皮损二期梅毒疹也有文 献报道[23] 。随着二期梅毒皮疹形态的多样性及少 见皮疹的增多,二期梅毒的误诊也会发生。 本例患者初诊时误诊原因: ①以荨麻疹性血管 炎表现的二期梅毒疹比较少见,初诊时依靠皮损诊 断疾病极易误诊; ②患者入院时否认不洁性交史,隐 瞒病史。仅以皮损表现需与荨麻疹性血管炎、荨麻 疹型药疹及离心性环状红斑等疾病鉴别。根据患者 发病前有明确不洁性交史、临床表现、梅毒血清学检 查及皮肤组织病理学检查,二期梅毒诊断明确。诊断梅毒一方面要依靠丰富的临床经验,另一 方面还需借助皮肤组织病理检查、免疫组织化学、血 清学检查等辅助检查可以减少误诊率[4]。治疗上 主要给予青霉素进行驱梅治疗,嘱患者定期复查。 日常诊疗过程中也要积极进行梅毒、 HIV、淋病等性 传播疾病的相关知识宣教。

参考文献略。

原始出处:

白瑶,石春蕊,刘昱彤,武奕等,二期梅毒误诊为荨麻疹性血管炎1 例[J],中国皮肤性病学杂志,2019,33(7):849-853.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1811229, encodeId=411e1811229db, content=<a href='/topic/show?id=1f188e273b4' target=_blank style='color:#2F92EE;'>#荨麻疹性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87273, encryptionId=1f188e273b4, topicName=荨麻疹性)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Sun Feb 16 03:54:00 CST 2020, time=2020-02-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2058434, encodeId=01ba2058434ee, content=<a href='/topic/show?id=386a23931e1' target=_blank style='color:#2F92EE;'>#二期梅毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23931, encryptionId=386a23931e1, topicName=二期梅毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Sat May 16 20:54:00 CST 2020, time=2020-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263231, encodeId=092d126323122, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Aug 31 10:54:00 CST 2019, time=2019-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355578, encodeId=402313555e865, content=<a href='/topic/show?id=0ff310302082' target=_blank style='color:#2F92EE;'>#麻疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103020, encryptionId=0ff310302082, topicName=麻疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 31 10:54:00 CST 2019, time=2019-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371978, encodeId=4fff3e197856, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=afa32365525, createdName=122e052cm96暂无昵称, createdTime=Thu Aug 29 20:38:22 CST 2019, time=2019-08-29, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1811229, encodeId=411e1811229db, content=<a href='/topic/show?id=1f188e273b4' target=_blank style='color:#2F92EE;'>#荨麻疹性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87273, encryptionId=1f188e273b4, topicName=荨麻疹性)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Sun Feb 16 03:54:00 CST 2020, time=2020-02-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2058434, encodeId=01ba2058434ee, content=<a href='/topic/show?id=386a23931e1' target=_blank style='color:#2F92EE;'>#二期梅毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23931, encryptionId=386a23931e1, topicName=二期梅毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Sat May 16 20:54:00 CST 2020, time=2020-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263231, encodeId=092d126323122, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Aug 31 10:54:00 CST 2019, time=2019-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355578, encodeId=402313555e865, content=<a href='/topic/show?id=0ff310302082' target=_blank style='color:#2F92EE;'>#麻疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103020, encryptionId=0ff310302082, topicName=麻疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 31 10:54:00 CST 2019, time=2019-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371978, encodeId=4fff3e197856, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=afa32365525, createdName=122e052cm96暂无昵称, createdTime=Thu Aug 29 20:38:22 CST 2019, time=2019-08-29, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1811229, encodeId=411e1811229db, content=<a href='/topic/show?id=1f188e273b4' target=_blank style='color:#2F92EE;'>#荨麻疹性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87273, encryptionId=1f188e273b4, topicName=荨麻疹性)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Sun Feb 16 03:54:00 CST 2020, time=2020-02-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2058434, encodeId=01ba2058434ee, content=<a href='/topic/show?id=386a23931e1' target=_blank style='color:#2F92EE;'>#二期梅毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23931, encryptionId=386a23931e1, topicName=二期梅毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Sat May 16 20:54:00 CST 2020, time=2020-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263231, encodeId=092d126323122, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Aug 31 10:54:00 CST 2019, time=2019-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355578, encodeId=402313555e865, content=<a href='/topic/show?id=0ff310302082' target=_blank style='color:#2F92EE;'>#麻疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103020, encryptionId=0ff310302082, topicName=麻疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 31 10:54:00 CST 2019, time=2019-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371978, encodeId=4fff3e197856, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=afa32365525, createdName=122e052cm96暂无昵称, createdTime=Thu Aug 29 20:38:22 CST 2019, time=2019-08-29, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1811229, encodeId=411e1811229db, content=<a href='/topic/show?id=1f188e273b4' target=_blank style='color:#2F92EE;'>#荨麻疹性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87273, encryptionId=1f188e273b4, topicName=荨麻疹性)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Sun Feb 16 03:54:00 CST 2020, time=2020-02-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2058434, encodeId=01ba2058434ee, content=<a href='/topic/show?id=386a23931e1' target=_blank style='color:#2F92EE;'>#二期梅毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23931, encryptionId=386a23931e1, topicName=二期梅毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Sat May 16 20:54:00 CST 2020, time=2020-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263231, encodeId=092d126323122, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Aug 31 10:54:00 CST 2019, time=2019-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355578, encodeId=402313555e865, content=<a href='/topic/show?id=0ff310302082' target=_blank style='color:#2F92EE;'>#麻疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103020, encryptionId=0ff310302082, topicName=麻疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 31 10:54:00 CST 2019, time=2019-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371978, encodeId=4fff3e197856, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=afa32365525, createdName=122e052cm96暂无昵称, createdTime=Thu Aug 29 20:38:22 CST 2019, time=2019-08-29, status=1, ipAttribution=)]
    2019-08-31 zhaojie88
  5. [GetPortalCommentsPageByObjectIdResponse(id=1811229, encodeId=411e1811229db, content=<a href='/topic/show?id=1f188e273b4' target=_blank style='color:#2F92EE;'>#荨麻疹性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87273, encryptionId=1f188e273b4, topicName=荨麻疹性)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Sun Feb 16 03:54:00 CST 2020, time=2020-02-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2058434, encodeId=01ba2058434ee, content=<a href='/topic/show?id=386a23931e1' target=_blank style='color:#2F92EE;'>#二期梅毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23931, encryptionId=386a23931e1, topicName=二期梅毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=10ba218, createdName=zgwhgch, createdTime=Sat May 16 20:54:00 CST 2020, time=2020-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1263231, encodeId=092d126323122, content=<a href='/topic/show?id=581e8968859' target=_blank style='color:#2F92EE;'>#血管炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89688, encryptionId=581e8968859, topicName=血管炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=909c71, createdName=shijzhiewnjhch, createdTime=Sat Aug 31 10:54:00 CST 2019, time=2019-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355578, encodeId=402313555e865, content=<a href='/topic/show?id=0ff310302082' target=_blank style='color:#2F92EE;'>#麻疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103020, encryptionId=0ff310302082, topicName=麻疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 31 10:54:00 CST 2019, time=2019-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371978, encodeId=4fff3e197856, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=afa32365525, createdName=122e052cm96暂无昵称, createdTime=Thu Aug 29 20:38:22 CST 2019, time=2019-08-29, status=1, ipAttribution=)]
    2019-08-29 122e052cm96暂无昵称

    0

相关资讯

NEJM:梅毒性秃头症-病例报道

具有“虫蛀”外观的非瘢痕性脱发是二期梅毒的特征。虽然梅毒性秃头症不常见,但它可能是患者临床表现中可观察到的二期梅毒唯一表现。头发通常在抗生素治疗后会再生。