HPV43／66感染致疣状表皮发育不良一例

A case of epidermodysplasia verruciformis caused by human papillomavirus 43/66 infection

患者男，37岁。因全身多发疣状丘疹、斑片20年，外阴和腹股沟糜烂、渗出2个月就诊。皮肤科检查：全身多发、蚕豆大疣状丘疹，部分融合成片。双侧腹股沟及外阴皮损处糜烂、渗液和结痂。外周血淋巴细胞亚群分析示：CD4＋T细胞37．2％，CD8＋T细胞43．6％，CD4＋／CD8＋细胞比值0．85。斑点杂交示：HPV43和66DNA阳性。皮损组织病理：角化过度，表皮疣状增生及假上皮瘤样增生，可见部分凹空细胞，真皮浅层中度淋巴细胞浸润。诊断为疣状表皮发育不良、皮肤感染和细胞免疫功能低下。治疗给予抗感染、肌内注射免疫增强剂和口服阿维A胶囊，治疗15d后外阴和腹股沟皮损表面干燥、变平，并有大量痂屑脱落，而躯干和四肢皮损无明显变化。目前患者仍在随访中。

A 37-year-old male was hospitalized due to widespread verrucous papules and patches over the body surface for over 20 years as well as erosive and exudative lesions in the inguinal and vulvar regions for two months. Skin examination revealed numerous round or polygonal, bean-sized verrueous papules on the face, trunk and extremities, with some coalescing into patches. The lesions on bilateral inguinal and vulvar areas were erosive and exudative with dirty crusts. Analysis of peripheral blood lymphocyte subsets showed that CD4~ T cells amounted to 37.2%, CD8＋ T cells 43.6%, and the CD4~/CD8＋ T cell ratio was 0.85. The tissue specimen was positive for human papillomavirus （HPV） 43 and 66 DNA by dot-blot hybridization. Histopathological examination indicated hyperkeratosis, verrueous hyperplasia and pseudo-epitheliomatous hyperplasia of the epidermis with the presence of some koilocytes, and moderate infiltration of the upper dermis with lymphocytes. He was diagnosed with epidermodysplasia verruciformis and cutaneous infection with non-specific cellular immune dysfunction, and given anti-infection therapy, intramuscular immunoenhancing agents and oral acitretin. After 15 days of treatment, the condition in the vulval and inguinal region greatly improved with shedding of crusts and desquamation, but the lesions on the trunk and extremities experienced no obvious changes. At the time of this writing, the patient was still followed up.