广泛尖锐湿疣在HIV阳性患者的病例报告和文献复习

Andreea Amuzescu, M. Tampa, D. Ionescu
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摘要

我们报告一例39岁男性患者,其多种合并症包括围产期缺氧导致的痉挛性麻痹,并伴有癫痫发作(用丙戊酸钠治疗),从小静脉注射药物滥用,慢性丙型肝炎病毒(HCV)感染和人类免疫缺陷病毒(HIV)感染。艾滋病毒感染需要多次住院并持续监测抗逆转录病毒联合治疗。他的免疫功能低下导致了2013年开始的耐多药结核分枝杆菌感染,首次出现在淋巴结,并进一步扩展到肺部、大脑和脾脏,2015年后得到缓解。自2018年以来,出现了不同的临床实体,患者在生殖器和腹股沟区域出现了多发尖锐湿疣。自行给予5mg/ml足臼毒素皮液治疗后,病变进展迅速。在最近的入院期间,临床表现包括广泛的外生菜花样突出,以及位于生殖器区域的平面棕色紫色肿瘤团块,完全覆盖腹股沟褶皱,阴茎基底和阴囊,没有自发缓解的趋势。住院期间进行多次冷冻治疗,联合25%的鬼臼碱乳膏。由于行走缺陷和不对称,左下肢比右下肢更内收,导致右侧腹股沟襞相对封闭,缺乏通气,容易形成水分和组织浸渍,故一侧愈合较慢。患者出院时指示使用含有茶树干叶提取物的软膏进行家庭治疗,并对一些持续存在的病变进行每月对照观察。关键词:人类免疫缺陷病毒(HIV),人乳头瘤病毒(HPV),肛周性传播疾病,肛门上皮内瘤变(AIN)
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EXTENSIVE CONDYLOMATA ACUMINATA IN A HIV - POSITIVE PATIENT - CASE REPORT AND LITERATURE REVIEW
We present the case of a 39-year old male patient with various comorbidities including spastic paraparesis due to peripartum hypoxia subsequent to a gemellary pregnancy, coexisting with seizures (under treatment with sodium valproate), intravenous drug abuse since childhood, chronic hepatitis C virus (HCV) infection and human immunodeficiency virus (HIV) infection. Numerous hospitalizations and continuously monitored combined antiretroviral therapy were required for HIV infection. His immunocompromised status led to an infection started in 2013 with multi-drug resistant Mycobacterium tuberculosis, debuted in a lymph node and further extended to the lungs, brain and spleen, remitted after 2015. Since 2018, a different clinical entity appeared and the patient presented multiple condylomas in the genital and inguinal regions. The lesions progressed rapidly despite the self-administered treatment with 5mg/ml podophyllotoxinum cutaneous solution. During the most recent admissions the clinical picture consisted of extensive exophytic cauliflowerlike protrusions as well as plane brown-violaceous tumour masses located in the genital area, completely covering the inguinal folds, penian basis and scrotum bilaterally, without tendency to spontaneous remission. During hospitalization, multiple cryotherapy sessions combined with podophyllin cream 25% were performed. Due to a deficiency and asymmetry in walking, with the left lower limb more adducted than the right one, leading to relative closure of the right inguinal fold, lack of ventilation and a tendency to moisture formation and tissue maceration, the healing was slower on this side. The patient was discharged with an indication for home treatment with an ointment containing Camellia sinensis dry leaf extract, remaining under observation with monthly controls for some persisting lesions. Keywords: Human immunodeficiency virus (HIV), Human papillomavirus (HPV), Perianal sexually transmitted diseases, Anal intraepithelial neoplasia (AIN)
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