Hicks C B, Benson P M, Lupton G P, Tramont E C
Ann Intern Med. 1987 Oct;107(4):492-5. doi: 10.7326/0003-4819-107-4-492.
Reagin and treponemal antibody tests are highly reliable in diagnosing secondary syphilis. However, patients infected with the human immunodeficiency virus (HIV) respond abnormally to antigenic stimulation and may fail to develop typical serologic responses to infections. We report the case of an HIV-infected man with Kaposi sarcoma and secondary syphilis whose VDRL test and fluorescent treponemal antibody-absorbed test were repeatedly nonreactive. Correct diagnosis required biopsy of a skin lesion with silver staining to show spirochetes. Clinicians treating HIV-infected patients should be aware of the problems of serologic diagnosis of syphilis in these patients. Biopsy samples of appropriate tissues and staining for spirochetes may be needed to arrive at the correct diagnosis.
反应素和梅毒螺旋体抗体检测在诊断二期梅毒方面高度可靠。然而，感染人类免疫缺陷病毒（HIV）的患者对抗原刺激反应异常，可能无法对感染产生典型的血清学反应。我们报告了一例患有卡波西肉瘤和二期梅毒的HIV感染男性病例，其性病研究实验室（VDRL）试验和荧光梅毒螺旋体抗体吸收试验多次呈阴性反应。正确诊断需要对皮肤病变进行活检并进行银染色以显示螺旋体。治疗HIV感染患者的临床医生应意识到这些患者梅毒血清学诊断的问题。可能需要对适当组织进行活检取样并对螺旋体进行染色才能得出正确诊断。
