肺梅毒性树胶肿的诊断及鉴别

Diagnosis and Differential of Pulmonary Syphilitic Gumma

肺梅毒性树胶肿是晚期梅毒患者免疫力低下时发生的罕见并发症,发病率低,临床表现无诊断特异性,易误诊。本文报道1例肺梅毒性树胶肿患者,血清学检查梅毒螺旋体颗粒凝集试验(TPHA)阳性,快速血浆反应素(RPR)阳性;右肺穿刺活检镜下见广泛中央坏死,伴周围大量淋巴细胞、浆细胞浸润,纤维组织增生。结合患者影像学改变,本文从感染性和非感染性疾病两方面对该病的鉴别诊断进行探讨,以提高临床对该病的认识。

Pulmonary syphilitic gumma is a rare complication which occurs in syphilitic patients of advanced stage with hypoimmunity. It has low morbidity and tends to be misdiagnosed due to a lack of diagnostic specificity. This paper reported a case of pulmonary syphilitic gumma. The serological examination showed TPHA positive and RPR positive; extensive central necrosis was observed in right lung biopsy under microscopy,as well as the infiltration of a large amount of lymphocytes and plasmocytes and the proliferation of fibrous tissue around it. According to imageological changes,we investigated the differential diagnosis of the disease in the aspects of infection and non- infection,in order to enhance the clinical understanding of the disease.