General Internal Medicine and Infectious Diseases, Hiroshima Prefectural Hospital, Hiroshima, Japan
General Internal Medicine and Infectious Diseases, Hiroshima Prefectural Hospital, Hiroshima, Japan.
BMJ Case Rep. 2024 Feb 17;17(2):e258549. doi: 10.1136/bcr-2023-258549.
A man in his 40s presented with pharyngeal pain and right cervical lymphadenopathy that persisted for 1 month. His right tonsil was swollen and covered with exudate; however, a rapid streptococcal antigen test was negative. Rapid plasma reagin and antibody were positive. Gram staining of the pus confirmed the presence of gram-negative corkscrew-like spirochaetes. The patient had unprotected oral intercourse. He did not have any skin lesions. He was diagnosed with primary syphilis and treated with benzathine penicillin G. In adults, the differential diagnosis of tonsillitis should include sexually transmitted diseases. A rapid streptococcal antigen test is not sufficient for such a case; a syphilis test is necessary, and Gram staining, which is rapid and does not need any special equipment, can support the diagnosis.
一位 40 多岁的男性出现咽部疼痛和右侧颈部淋巴结病,持续 1 个月。他的右侧扁桃体肿胀,覆盖有渗出物;然而,快速链球菌抗原检测呈阴性。快速血浆反应素和抗体呈阳性。脓液的革兰氏染色证实存在革兰氏阴性螺旋体。患者有过无保护的口交行为。他没有任何皮肤损伤。他被诊断为原发性梅毒,并接受了苄星青霉素 G 治疗。在成年人中,扁桃体炎的鉴别诊断应包括性传播疾病。对于这种情况,快速链球菌抗原检测并不足够;需要进行梅毒检测,而革兰氏染色快速且不需要任何特殊设备,可以支持诊断。