Patrício Catarina, Campos Sara, João Alexandre, Serrão Vasco
Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal.
Department of Dermatology, Hospital de Santo António dos Capuchos, Lisboa, Portugal.
BMJ Case Rep. 2015 Aug 26;2015:bcr2015210285. doi: 10.1136/bcr-2015-210285.
A previously healthy 24-year-old man presented with an erythematous, non-pruritic and painless papulonodular skin rash affecting the trunk, upper arms (excluding palms), neck, face, forehead and scalp. He had a penile ulcer for the past 2 weeks, almost healed at the time of observation. The patient tested positive for syphilis and HIV-1; he claimed being negative for HIV 6 months earlier. As the palms were not affected, we performed a skin biopsy for the differential diagnosis between secondary lues and acute HIV seroconversion reaction. Benzathine penicillin (2,400,000 units) was administrated and antiretroviral therapy started. Although the skin biopsy was compatible with secondary syphilis, there was no change in the skin rash 3 weeks after the first penicillin administration. Another 2 doses of penicillin were given but 4 weeks later the rash persisted. A second biopsy revealed a mucinous skin infiltration, compatible with nodular mucinosis.
一名既往健康的24岁男性，躯干、上臂（不包括手掌）、颈部、面部、前额和头皮出现了红斑性、非瘙痒性且无痛的丘疹结节性皮疹。他在过去2周有阴茎溃疡，在观察时几乎已愈合。该患者梅毒和HIV-1检测呈阳性；他声称6个月前HIV检测为阴性。由于手掌未受累，我们进行了皮肤活检以鉴别二期梅毒和急性HIV血清转化反应。给予苄星青霉素（240万单位）并开始抗逆转录病毒治疗。尽管皮肤活检结果符合二期梅毒，但首次给予青霉素3周后皮疹并无变化。又给予了2剂青霉素，但4周后皮疹仍持续存在。第二次活检显示为黏液性皮肤浸润，符合结节性黏液水肿。
