艾滋病合并梅毒血清试验异常的二期梅毒1例

A Case of Syphilis and HIV Co-infection in a Secondary Syphilis Patient with Anomalous Serological Test for Syphilis

患者男,43岁,系男男同性恋者,确诊为艾滋病并予高效抗逆转录病毒治疗(HAART)1年余。患者双手掌及双足跖丘疹、斑块、鳞屑伴瘙痒3个月。TPPA(+),TRUST(-)。皮损组织病理:真皮浅深层血管扩张,管周见淋巴细胞、组织细胞及浆细胞浸润。予苄星青霉素驱梅治疗后出现吉海反应,3个月后复查皮疹消退,但TRUST试验由阴性转为阳性(1∶1),加倍剂量驱梅治疗,24个月随访,查TPPA(+),TRUST(-),皮损无复发。诊断:①艾滋病;②二期梅毒。

A 43 year-old MSM （ men who have sex with men） , has been diagnosed with AIDS and received the highly active antiretroviral therapy（HAART） for more than I year. This patient presented with a 3-month history of papules, plaques, scaly with itchy on his hands and feet plantar. Serum treponema pallidum particle agglutination（TPPA） test was positive, and toludine red unheated serum test （TRUST）was negative. Histopathologic examination showed that blood vessel vasodilation, and infiltration of perivascular lymphocytes, histiocytes and plasma cells in the superficial dermis. Jarisch-Herxheimer reaction occurred during the first dosage of Benza- thine penicillin. Three months later, the skin rash disappeared, and the TRUST test turned to be negative （ 1 ： 1 ）. 24 months later,TPPA test was positive while TRUST test was negative,without recurrent lesions. The diagnosis of AIDS and Secondary syphilis were made.