植物性皰疹瘡（亦稱為肥厚性單純皰疹瘡）

資料來源： N ENGL J MED 388;26 / NEJM.ORG 2023 年 6 月 29 日

一名感染人類免疫缺陷病毒 (HIV) 的 39 歲男性正在接受抗反轉錄病毒治療，他因陰莖潰瘍反復發作、疼痛已有 1 年就診於皮膚科診所。大約每月一次，他的陰莖幹會出現糜爛，潰瘍，無需特殊治療即可治癒，然後復發。體格檢查發現兩個外生斑塊，中央潰瘍，邊緣凸起。在癒合的病變部位也有色素減退的斑塊。實驗室檢測顯示，CD4 細胞計數為每立方毫米 494 個（參考範圍，414 至 1123），HIV 病毒載量為每毫升 450 個拷貝（參考範圍，< 20）。病變活檢顯示表皮壞死、假上皮瘤樣表皮增生以及真皮和皮下新生組織中炎症細胞緻密浸潤。用於檢測性傳播感染 (STI) 的新一代測序檢測鑑定出單純皰疹病毒第2 型 (HSV)。其他微生物檢測呈陰性。診斷為植物性皰疹。植物性皰疹（也稱為肥厚性單純皰疹）是免疫功能低下人群中 HSV 感染的一種罕見表現。它表現為疣狀、增生性或潰瘍性病變，通常具有慢性、持續性病程。給予口服伐昔洛韋 (valacyclovir) 治療。其他性傳播感染的篩查結果為陰性。在兩週的追蹤中，病變已經減輕。

DOI：10.1056/NEJMicm2215873

Herpes Vegetans

Stephanie V. Sherman, M.D., Editor / N ENGL J MED 388;26 / NEJM.ORG JUNE 29, 2023

A 39-year-old man with human immunodeficiency virus (HIV) infection that was being treated with antiretroviral therapy presented to the dermatology clinic with a 1-year history of recurrent, painful penile ulcers. Approximately once per month, erosions would appear on his penile shaft, ulcerate, heal without specific treatment, and then recur. On physical examination, there were two exophytic plaques with central ulceration and raised borders. There were also hypopigmented patches at the sites of healed lesions. Laboratory testing showed a CD4 cell count of 494 per cubic millimeter (reference range, 414 to 1123) and an HIV viral load of 450 copies per milliliter (reference range,< 20). Biopsies of the lesions revealed epidermal necrosis, pseudoepitheliomatous epidermal hyperplasia, and a dense infiltrate of inflammatory cells in the dermis and subcutaneous tissue. A next-generation sequencing assay to detect sexually transmitted infection (STI) identified herpes simplex virus (HSV) type 2. Other microbiologic testing was negative. A diagnosis of herpes vegetans was made. Herpes vegetans — also known as hypertrophic herpes simplex — is an uncommon manifestation of HSV infection seen in persons with immunocompromise. It manifests as verrucous, proliferative, or ulcerative lesions, often with a chronic, persistent course. Treatment with oral valacyclovir was given. Screening for other STIs was negative. At a 2-week follow-up, the lesions had abated.

DOI: 10.1056/NEJMicm2215873

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