猴痘患者生殖器上之傷口

資料來源： N ENGL J Med 387;1 / nejm.org July 7, 2022 / 財團法人台灣紅絲帶基金會編譯

一名 31 歲男性，人類免疫缺乏病毒感染控制良好，因 1 周無痛性生殖器皮疹病史和 2 天發燒和喉嚨痛病史到診所就診。三週前，他與一位新的男性伴侶進行了無套性交。在身體檢查中，在右側腹股溝區域觀察到黃斑皮疹和疼痛性淋巴結病（圖 A），在陰莖上觀察到兩個潰瘍性病變和幾個臍狀膿皰（圖 B）。梅毒、衣原體和淋病檢測均為陰性。並開始對可能的性病性淋巴肉芽腫和硬性下疳進行抗菌治療。初次就診 5 天後，患者再次出現面部和手部水皰膿皰病變。從生殖器和手上的損傷處獲得之拭子的聚合酶鏈反應試驗對猴痘呈陽性。在典型的猴痘病例中，患者會出現發熱前驅症狀，隨後出現皮疹，皮疹可能出現在身體的任何部位，並且皮疹會同時發展。在當前全球新爆發的猴痘疫情中，在與感染者密切接觸的人（包括男男性行為者）中觀察到無痛性肛門生殖器病變（通常沒有前驅症狀）。在首次就診後的 2 週內，患者的病變在沒有特殊介入的情況下減輕了。在其他患者中觀察到的猴痘生殖器病變的其他示例顯示在片 C 和 D 中。

DOI: 10.1056/NEJMicm2206893

Monkeypox Genital Lesions

A 31-year-old man with well-controlled infection with the human immunodeficiency virus presented to the clinic with a 1-week history of a painless genital rash and a 2-day history of fever and sore throat. Three weeks earlier, he had had condomless intercourse with a new male partner. On physical examination, a macular rash and painful lymphadenopathy were observed in the right inguinal area (Panel A), and two ulcerated lesions and several umbilicated pustules were observed on the penis (Panel B). Tests for syphilis, chlamydia, and gonorrhea were negative. Antimicrobial therapy for possible lymphogranuloma venereum and chancroid was initiated. Five days after the initial presentation, the patient returned with vesiculopustular lesions on the face and hands. Polymerase-chain-reaction assays of swabs obtained from lesions on the genitals and the hands were positive for monkeypox. In classic cases of monkeypox, patients have a febrile prodrome followed by a rash that may appear on any part of the body, with lesions that evolve simultaneously. In the current global outbreak of monkeypox, painless anogenital lesions — often without a prodrome — are being observed in persons who have had close contact with an infected person or persons, including men who have sex with men. Within 2 weeks after his initial presentation, the patient’s lesions had abated without specific intervention. Additional examples of monkeypox genital lesions that were observed in other patients are shown in Panels C and D. 

DOI: 10.1056/NEJMicm2206893