外阴、肛周扁平湿疣1例

报告1例以外阴、肛周扁平湿疣为主要临床皮肤表现的二期梅毒。患者女,15岁,因"外阴、肛周多发丘疹伴瘙痒10d,阴道流血2d"就诊,本例患者既往有非婚性生活史。实验室检查:梅毒非特异性血清试验(TRUST)阳性(+),滴度1∶32,梅毒螺旋体颗粒凝集试验(TPPA)阳性。最后诊断:二期梅毒。经头孢曲松钠驱梅治疗10d后,皮损大部分消失。     

获得性梅毒性颅骨炎合并梅毒性脑膜炎

报告国内首例获得性梅毒性颅骨炎合并梅毒性脑膜炎.患者女,55岁,2个月前无诱因于头顶部和枕部出现持续性胀痛.磁共振成像T1加权像提示:颅骨多发性病变,邻近脑膜线状强化.查血快速血浆反应素环状卡片试验(RPR)1:32阳性,梅毒螺旋体明胶凝集试验(TPPA)阳性;脑脊液检查:白细胞10×106/L,蛋白0.82 g/L,RPR 1∶4阳性,TPPA阳性;额骨骨膜梅毒螺旋体DNA阳性.组织病理示:颅骨灶性溶骨性破坏,骨纹理模糊,碎骨组织周围和硬膜样组织充血,间质纤维组织增生,内皮细胞肿胀,大量浆细胞为主炎细胞浸润.治疗:按神经梅毒的治疗方案治疗,头痛于治疗3d后缓解,15d后基本消失,30 d后完全消失,之后未再出现类似的头痛.随访5年,近期疗效和远期疗效均满意.最终诊断:梅毒性颅骨炎合并梅毒性脑膜炎.     

三期神经梅毒--麻痹性痴呆1例

患者男，40岁。进行性记忆力减退，言语忘词1年，大小便失禁，行走不稳3d入院。脑脊液检查示梅毒螺旋体抗体阳性；血快速血浆反应素试验(RPR)阳性、梅毒微粒凝集试验(TPPA)阳性；青霉素治疗后症状明显缓解。诊断为三期神经梅毒麻痹性痴呆。     

梅毒治疗出现阿瑟氏反应1例

正1病历摘要患者女,54岁。因阑尾炎手术术前常规检查发现梅毒螺旋体颗粒凝集试验(TPPA)阳性,快速血浆反应素(RPR)试验滴度1∶8 10 d,于2018年11月12日至宿迁市第一人民医院皮肤科就诊。患者无梅毒临床症状,但10 d前行阑尾炎手术术前常规检查时发现TPPA阳性,RPR试验滴度1∶8。既往无梅毒病史,诊断为潜伏梅毒。青霉素皮试阴性,双侧臀部予以肌内注射苄星青霉素(规格:每支120万单位;批号:076170553;生产厂     

早期先天梅毒1例

报告1例以四肢弯曲痛为惟一症状的早期先天梅毒。患儿女，70d。四肢弯曲痛40d。未见明显皮损，全身浅表淋巴结未触及。实验室检查；快速血浆反应素试验（RPR）阳性，滴度1：128；梅素螺旋体血凝试验（TPHA）阳性。上、下肢X线摄片示；层状骨膜反应，双侧下肢见对称性骨质破坏。诊断：早期先天梅毒。经正规驱梅治疗后，症状消失，梅毒血清学试验阴转。     

误诊为尿布皮炎的早期先天梅毒一例

患儿,男,4个月。臀部、阴囊、股部红斑1个月。曾于多家医院诊断为尿布皮炎,治疗无效。患儿TPPA阳性,TRUST 1∶512,抗梅毒螺旋体IgM阳性。患儿父母均无皮疹,TPPA均阳性,母亲TRUST滴度1∶32;父亲TRUST滴度1∶64。患儿母亲孕期未进行围产期保健,否认梅毒诊治史,分娩时医院发现母亲血梅毒抗体阳性,未对患儿进行梅毒抗体检测。早期先天性梅毒症状缺乏特异性,容易误诊,医生应予以重视,对疑似梅毒患儿行梅毒抗体检测。     

RPR持续阳性梅毒患者脑脊液梅毒检测的意义

目的　观察RPR持续阳性梅毒患者无症状神经梅毒的发生情况 ,并探讨其临床意义。方法　对 69例经过数疗程常规驱梅治疗但RPR持续阳性 ( 1年以上 )且无神经系统临床表现的梅毒患者的脑脊液进行梅毒抗体检测。结果　有 16例梅毒患者脑脊液存在梅毒抗体。结论　部分RPR持续阳性梅毒患者存在无症状神经梅毒 ,可能是RPR持续阳性的原因之一。     

性传播疾病

20140935梅毒螺旋体IgM抗体在梅毒血清固定中的应用/俞莺（无锡市第五医院皮肤科）,袁波∥中国性科学.-2013,22（1）.-33-36 198例RPR阳性患者病程1周-5年,其中28例病程1年以上,且RPR滴度固定;二期梅毒17例,潜伏梅毒11例。应用抗原特异性免疫印迹法检测IP-IgM抗体,阳性8例,阴性20例;其中二期梅毒阳性5例,阴性12例,潜伏梅毒阳性3例,阴性8例。     

早期梅毒非生殖器部位少见皮损误诊六例分析

近年来,性病患者日趋增多,其中梅毒因其临床表现多样化而易误诊。我们近来在门诊发现 6例以非生殖器部位少见皮疹为特征的梅毒患者,现报道如下。 一、临床资料 患者均为女性,年龄 19～ 55岁;病程 45 d至 6个月; 1例确诊为二期显发梅毒, 5例确诊为二期复发梅毒; 6例患者皮损梅毒螺旋体暗视野检查均阳性,血清 RPR、 TPHA检查均阳性;除 1例左颌下淋巴结肿大外,其余 5例患者均无浅表淋巴结肿大。 例 1上唇内侧左右排列 4个黄豆至花生米大小的浅表溃疡,软骨样硬度,境界清晰,边缘轻度潮红、浸润,溃疡边缘高起,皮损基底平坦…     

广西早期梅毒患者梅毒螺旋体基因分型研究

目的 了解广西部分市梅毒螺旋体(Tp)的基因分型状况.方法 从2012年1月至2016年7月在广西性病门诊收集疑似早期梅毒患者300例,采集皮损处组织液,用镀银染色法检测梅毒螺旋体,同时采用PCR扩增Tp polA基因,进行早期梅毒的诊断.对早期梅毒确诊病例进行Tp的arp基因60个碱基对重复序列的数目、tprⅡ基因MseⅠ酶切后限制性片段长度多态性的型别和tp0548基因序列的型别进行鉴别,依据结果进行综合分析以判断梅毒基因型.结果 共确诊早期梅毒患者215例,其中梅毒PCR检测出210例阳性,检出率97.7%,镀银染色法检测出105例阳性,检出率48.8%,PCR法阳性率显著高于镀银染色法(χ2=103.01,P<0.05).在PCR阳性标本中,共190例可进行三基因完全分型,总计分出17个基因型别,14d/f有86例(45.3%),具有绝对的流行优势,其他亚型依次为15d/f(13.7%、26/190)、16d/f(11.6%、22/190)、17d/f(7.4%、14/190)、13d/f(6.8%、13/190)、10d/f(4.2%、8/190)、18d/f(1.6%、3/190)、16a/f(1.6%、3/190)、5d/f(1.1%、2/190)、7d/f(1.1%、2/190)、12d/f(1.1%、2/190)、16d/e(1.1%、2/190)、14a/f(1.1%、2/190)、9h/c(1.1%、2/190)、15l/f(0.5%、1/190)、25a/e(0.5%、1/190)、15i/f(0.5%、1/190).结论 广西早期梅毒患者的梅毒螺旋体基因型别具有多样性,其中以14d/f型为优势型.     

Transient Porphyrinemia in a Neonate: A Case Report

We describe a neonate with anemia, thrombocytopenia, and hyperbilirubinemia secondary to hemolytic disease of the newborn. After phototherapy for hyperbilirubinemia, the neonate developed a photodistributed eruption with high serum and urine porphyrin levels. This transient porphyrinemia resolved at 1 month.     

A case of neonatal pemphigus vulgaris with co-existing BP180 autoantibodies

A male neonate was born with blisters on the trunk to a 37-year-old primigravid woman with a past medical history of recurrent, painful, topical steroid-responsive oral blisters. The diagnosis of neonatal pemphigus was made after the neonate and mother were found to have elevated desmoglein 3 (Dsg3) antibodies in conjunction with histopathologic features of pemphigus vulgaris. Interestingly, both neonate and mother also had elevated levels of BP180 antibodies, classically seen in bullous pemphigoid. This case is unique in that it portrays neonatal pemphigus, an already rare condition, complicated by the presence of BP180 antibodies.     

Violaceous Maculopapular Rash in a Newborn: Congenital Rubella Syndrome

Congenital rubella syndrome involves a configuration of systemic and cutaneous manifestations in a neonate due to in utero infection caused by the rubella virus. The case of a preterm neonate with blueberry muffin lesions and classical as well as rare systemic features of congenital rubella syndrome is reported.     

Herpes gestationis in a mother and newborn: immunoclinical perspectives based on a weekly follow-up of the enzyme-linked immunosorbent assay index of a bullous pemphigoid antigen noncollagenous domain

BACKGROUND: Herpes gestationis (HG) is a rare, autoimmune, bullous disease that occurs during the second or third trimester and usually resolves over weeks or months after delivery. Neonates with HG are rare (estimated at 1 per 100,000 cases). Although anti-180-kDa bullous pemphigoid (BP180) autoantibody and transfer of this autoantibody are known as the cause, to our knowledge, no coordinated analysis of clinical symptoms and anti-BP180 antibody enzyme-linked immunosorbent assay titers has been reported in a mother and neonate with HG. OBSERVATIONS: We describe a 33-year-old woman with HG and her neonate with vesicular erythematous lesions and the weekly follow-up results of the BP180 noncollagenous domain (NC16a) enzyme-linked immunosorbent assay. CONCLUSIONS: Almost the same titer of pathogenic antibody as that in the mother is transferred to the neonate. The plasma elimination half-life of anti-BP180 antibody is approximately 15 days in mother and neonate. An abrupt twin peak increase in the BP180 enzyme-linked immunosorbent assay index from maternal serum was observed just before and after delivery, possibly explaining why HG usually occurs in the last trimester of pregnancy and exacerbates postpartum. Lesions in the neonate resolve without treatment far before pathogenic antibody disappears, suggesting that factors other than anti-BP180 antibodies may be involved in the generation of eruptions. Frequent testing of the BP180 enzyme-linked immunosorbent assay greatly facilitates therapeutic planning.     

White Epidermal Nevi at Birth in a Patient with Tuberous Sclerosis

We report a neonate who presented at birth with multiple, scattered, white macerated plaques. Punch biopsy confirmed epidermal nevi. At 3 months of age the patient presented with infantile spasms and, after full evaluation, was diagnosed with tuberous sclerosis complex (TSC). We suggest that physicians consider TSC in a neonate with epidermal nevi inconsistent with any described epidermal nevus syndrome.     

Antiphospholipid syndrome in a neonate

Antiphospholipid syndrome presenting in the neonatal period is very rare. Although antiphospholipid antibodies from mothers with antiphospholipid syndrome can cross the placenta and put their neonates at risk, the occurrence of thrombotic complications in these neonates is uncommon. We present a 10-day-old neonate who developed Klebsiella sepsis with arterial gangrene of the left lower limb. Investigations revealed thrombosis of the left femoral artery with both the mother and the neonate positive for antiphospholipid antibodies. In conclusion, passive transfer of antiphospholipid antibodies from mothers to their offspring can be associated with significant complication in the presence of secondary risk factors.     

Transient myeloproliferative disorder causing a vesiculopustular eruption in a phenotypically normal neonate

We report an unusual congenital vesiculopustular eruption arising in a neonate as the result of the transient myeloproliferative disorder (TMD) associated with trisomy 21. In this instance, the neonate was phenotypically normal, making the diagnosis more elusive. Initially the lesions were clinically suspicious for herpetic infection. The clinical scenario quickly became highly suggestive of leukemia cutis, given the infant's extremely high white blood cell count. Further examination revealed trisomy 21 in the leukemic cells and disomy 21 in the buccal keratinocytes, and a diagnosis of self-resolving TMD was made. Biopsy specimens of the lesions showed a sparse, perivascular, atypical, mononuclear infiltrate. We suggest that examination for a TMD be undertaken in neonates with a vesiculopustular eruption and leukemic white blood cell counts.     

Paired unilateral scapular pits in a neonate

Congenital skin pits have been observed as a sporadic anatomic variant as well as in association with trauma, maternal infection, genetic syndromes, and metabolic disorders. We present a case of a neonate with paired unilateral scapular pits, which to our knowledge has not yet been reported. Although this is favored to be a benign finding in an otherwise healthy baby, we review important considerations in the clinical evaluation of a neonate with congenital skin pitting.     

Fatal Pseudomonas Septicemia and Vasculitis in a Premature Infant

Abstract: A characteristic vasculitis is an uncommon but wellrecognized complication of severe Pseudomonas aeruginosa infection in the neonate. Although it is one of the most common gram-negative organisms responsible for overall nosocomial infection, it is a rare cause of intrauterine or intrapartum infection of the newborn. We describe a fatal Pseudomonas aeruginosa infection occurring in a very premature infant with widespread skin necrosis. Although this organism is relatively uncommon in the neonate, premature infants are at increased risk of infection, with a significant associated mortality. Early recognition and treatment are therefore very important.     

Sebum excretion rates in mothers and neonates

As neonates have a high sebum production compared with 6-month-old babies, we wished to investigate the relationship of sebum production in mother and neonate. The sebum excretion rate (SER) was therefore measured in 10 mothers prenatally, and in each mother and baby as soon after birth as possible, and again 5-12 weeks postnatally. There was a significant correlation between the maternal and neonatal SER perinatally. The perinatal SER in the babies was markedly higher than the postnatal sample. These observations suggest an important role for the maternal hormonal environment on the infant sebaceous glands. There is animal evidence which suggests that the endocrine environment of the neonate influences the sebaceous gland development in puberty, but it is not known whether babies with a high SER are more prone to seborrhoea and acne in later life.