Atsushi Yamanaka,醫學士、博士;Naoki Ga,醫學士 / 2024 年 3 月 7 日

/ n engl j med 390;10

一名 40 歲男子被轉診至日本宮崎縣宮崎醫院耳鼻喉科診所,有 1 個月喉嚨痛病史。 他報告沒有上呼吸道症狀、發燒、皮疹或生殖器病變。 他(他的兄弟)有白塞氏症家族史。 身體檢查中值得注意的是非潰瘍性白色斑塊,這些斑塊在口咽後部、上懸雍垂和扁桃體上形成蝴蝶形狀(圖 A)。 沒有淋巴結腫大或皮膚或生殖器病灶。 咽喉細菌培養培養出正常菌叢。 斑塊切片顯示密集的淋巴漿細胞浸潤。 梅毒螺旋體血凝試驗呈陽性,快速血漿反應素水準為122.4 U(參考範圍,00.9)。 獲得了進一步的病史,患者報告在症狀出現前 2 個月曾與商業性工作者發生性行為。 隨後對活檢標本進行的梅毒螺旋體免疫組織化學染色呈陽性(圖 B)。 人類免疫缺乏病毒感染檢測呈陰性。 診斷為梅毒性咽炎(二期梅毒的一種表現)。 由於缺乏芐星青黴素 G (benzathine penicillin G),根據當地指引給予阿莫西林 (amoxicillin) 治療。 治療開始後1個月追蹤時,患者的症狀減輕。

DOI: 10.1056/NEJMicm2310515

Atsushi Yamanaka醫學士、博士;Naoki Ga醫學士

宮崎縣宮崎醫院 ,日本宮崎ayaman@pref-hp 。 日本宮崎。

Syphilitic Pharyngitis

Atsushi Yamanaka, M.D., Ph.D. Naoki Ga, M.D. / March 7, 2024 / n engl j med 390;10

A40-year-old man was referred to the otorhinolaryngology Miyazaki Prefectural Miyazaki Hospital Miyazaki, Japan ayaman@ pref-hp . miyazaki . miyazaki . jp 934 clinic with a 1-month history of a sore throat. He reported no upper respi ratory symptoms, fever, rash, or genital lesions. He had a family history of Behçet’s disease (in his brother). The physical examination was notable for nonulcer ated white plaques that formed a butterfly shape across the posterior oropharynx, upper uvula, and tonsils (Panel A). No lymphadenopathy or skin or genital lesions were present. A bacterial throat culture grew normal flora. A biopsy of the plaques showed dense lymphoplasmacytic infiltration. A Treponema pallidum hemaggluti nation assay was positive, and the rapid plasma reagin level was 122.4 U (reference range, 0 to 0.9). Further history was obtained, and the patient reported having had sexual intercourse with a commercial sex worker 2 months before the onset of symptoms. Subsequent immunohistochemical staining for T. pallidum performed on the biopsy specimen was positive (Panel B). Testing for human immunodeficiency virus infection was negative. A diagnosis of syphilitic pharyngitis — a manifestation of secondary syphilis — was made. Owing to the lack of availability of benzathine penicillin G, treatment with amoxicillin was given in accordance with local guide lines. At follow-up 1 month after the start of treatment, the patient’s symptoms had abated.

DOI: 10.1056/NEJMicm2310515 Copyright © 2024 Massachusetts Medical Society

Atsushi Yamanaka, M.D., Ph.D. Naoki Ga, M.D.

Miyazaki Prefectural Miyazaki Hospital Miyazaki, Japan

ayaman@ pref-hp . miyazaki . miyazaki . jp

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