中国麻风皮肤病杂志 ›› 2023, Vol. 39 ›› Issue (8): 551-554.doi: 10.12144/zgmfskin202308551

• 猴痘快报 • 上一篇    下一篇

以冠状沟斑块为首发表现的猴痘一例报道并文献复习

王天姿,初同胜,槐鹏程,王猛,暴芳芳,刘永霞,王川,田洪青,张福仁   

  1. 山东第一医科大学附属皮肤病医院(山东省皮肤病医院),山东省皮肤病性病防治研究所,山东济南,250022
  • 出版日期:2023-08-15 发布日期:2023-07-19

A case of monkeypox with plaques on the balanus as the first manifestation and literature review

WANG Tianzi, CHU Tongsheng, HUAI Pengcheng, WANG Meng, BAO Fangfang, LIU Yongxia, WANG Chuan, TIAN Hongqing, ZHANG Furen   

  1. Shandong Provincial Hospital for Skin Disease & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250022, China
  • Online:2023-08-15 Published:2023-07-19

摘要: 患者,男,25岁,汉族。9天前患者龟头出现灰白色斑块,6天前出现咽痛、发热,2天前全身多部位出现散在红斑、丘疱疹、水疱。发病前4天有无保护男男性行为,曾被疑诊为梅毒、单纯疱疹。查体:咽后壁潮红,双侧颈部、右侧腹股沟各有一黄豆大的肿大淋巴结,有触痛。面部、颈部、躯干、上肢散在红斑,其上有米粒大水疱、丘疱疹或脓疱,冠状沟处多个灰白色环状隆起性斑块,表面少许黏性分泌物,质韧,触痛明显。冠状沟斑块组织病理示:表皮片状坏死,坏死周围表皮网状变性,见气球状细胞及嗜中性粒细胞、核尘,真皮浅中层血管坏死出血,浅深层血管周围淋巴细胞浸润。咽拭子、面部、上肢、背部水疱疱液、冠状沟斑块分泌物、血液等标本的猴痘病毒qPCR检测结果均为阳性。根据无保护男男性行为史、临床表现、组织病理表现和猴痘病毒qPCR检测结果诊断为猴痘。

关键词: 猴痘, 猴痘病毒, 男男性行为

Abstract: A 25-year-old male of Han nationality presented with gray plaques on the balanus for 9-days, sore throat and fever for 6 days and erythema, papulovesicles and vesicles scattered over the body for 2 days. The patient has a history of unprotected MSM 4 days before onset of illness. Physical examination revealed a congested posterior pharyngeal wall and three soy-sized enlarged lymph nodes with tenderness on both sides of the neck and on the right groin. Erythema scattered on his face, neck, trunk and upper limbs with rice-sized vesicles, papulovesicles and pustules. It was noted that multiple gray-white annular protuberant plaques located in the coronary sulcus with sticky secretions on the surface, leathery and tender. Histopathology of the plaque in coronary sulcus showed patchy necrosis surrounded by reticular degeneration in epidermis, with balloon-like cells, neutrophils and nuclear dust. There was also hemorrhage and necrosis vessels in superficial and middle dermis, as well as perivascular lymphocytic infiltration in superficial and deep dermis. qPCR results of monkeypox virus was positive in specimens such as blood, throat swabs, secretion of plaques on the coronal sulcus, swabs of vesicles on the face, upper limbs, and back. The diagnosis of monkeypox was confirmed based on the history of unprotected sex with men, clinical and histopathological manifestations, and positive qPCR results.

Key words: monkeypox, monkeypox virus, MSM