人免疫缺陷病毒感染并发毛囊黏蛋白病一例

A case of HIV infection with follicular mucinosis

42岁男性患者,面颈部、躯干及四肢丘疹1年余。面颈部、躯干及四肢散在米粒至绿豆大小肤色或淡红色丘疹,部分丘疹表面凹陷结痂,散在抓痕、血痂及瘢痕;眉毛稀疏、脱落,以眉外侧为著;四肢痛温觉正常。幼年有猪咬伤史,2年前有非婚性行为史。人免疫缺陷病毒(HIV)抗体初筛及确证实验均为阳性。丘疹组织病理示:表皮角化过度,棘层增生肥厚,中央部分缺失,表面有痂形成;真皮全层血管周围散在或小片状的淋巴细胞及组织细胞浸润,毛囊水肿明显,有较多黏蛋白沉积,周围可见密集的淋巴细胞、组织细胞及嗜酸粒性细胞浸润。阿新兰染色阳性,抗酸染色阴性,真菌培养阴性。诊断:(1)HIV感染(无症状感染期);(2)毛囊黏蛋白病。予以艾滋病阻断治疗,皮损未特殊处理。治疗2周后大部分皮损消退,随访2年,皮损无新发,血常规及T细胞亚群检测无明显异常。

A 42-year-old male patient had papules on the face,neck,trunk and extremities for more than 1 year.On the areas mentioned above there were scattered from rice grains to soybean sized skin color or light red papules,scratches,blood scabs and scars,and the surface of some papules were sunken and covered by crust.The eyebrows of the patient were sparse and shedding,especially on the outside of eyebrows,but the hair did not fall off,the superficial lymph nodes were not swollen,the feeling of the limbs was normal.The patient had a history of pig bites in childhood and a history of high-risk sexual behavior more than a year before onset.HIV antibody initial screening and confirmatory test were positive.Histopathology of papules showed that hyperkeratosis with hypertrophy of the spinous layer,the central part of the lesion lost and covered by crust,scattered or small pieces of lymphocytes and histocytes infiltrated around blood vessels throughout the dermis,obvious hair follicle edema with a large mount of mucin deposition as well as dense infiltration of lymphocytes,histiocytes and eosinophils around the follicles.Alcian blue staining was positive,acid fast staining and fungal culture were negative.AIDS blockage treatment was adopted,without special treatment for the skin lesions.Most of the skin lesions subsided after half a month of treatment and no new lesions were found during the two years of follow-up.There were no abnormalities in blood routine and T cell subgroup detection.