CAJ | 학술논문

患者男,53岁,冠状沟增生物2年,腹股沟包块红肿、疼痛、破溃2月余.体检:双侧腹股沟淋巴结红肿约2 cm×1.5 cm,质硬,触痛,右侧腹股沟肿大淋巴结中心波动,其上见多处破溃及黄白色脓性分泌物流出,如喷水壶状.多个肿大或破溃淋巴结被腹股沟韧带分隔,形成明显的沟槽征.冠状沟两侧可见1 cm×2 cm不规则疣状增生,质硬,表面角化.龟头系带处红肿,有波动,并有破溃伴黄白色脓液渗出,右侧阴囊肿胀.龟头系带处分泌物及左右侧腹股沟穿刺液多次真菌培养阴性,细菌培养阴性,抗酸染色阴性,沙眼衣原体培养初次为阴性,衣原体内源性质粒PCR检测阳性,omp1-限制性片段长度多态性(RFLP)分型为L3型.Western印迹示血清沙眼衣原体主要外膜蛋白(MOMP)抗体阳性,多形外膜蛋白H(PmpH)抗体＞1:800,衣原体多代培养阳性.右腹股沟疣状增生处活检示皮肤高分化鳞状细胞癌.诊断:性病性淋巴肉芽肿合并皮肤鳞状细胞癌.
환자남,53세,관상구증생물2년,복고구포괴홍종、동통、파궤2월여.체검:쌍측복고구림파결홍종약2 cm×1.5 cm,질경,촉통,우측복고구종대림파결중심파동,기상견다처파궤급황백색농성분비물류출,여분수호상.다개종대혹파궤림파결피복고구인대분격,형성명현적구조정.관상구량측가견1 cm×2 cm불규칙우상증생,질경,표면각화.구두계대처홍종,유파동,병유파궤반황백색농액삼출,우측음낭종창.구두계대처분비물급좌우측복고구천자액다차진균배양음성,세균배양음성,항산염색음성,사안의원체배양초차위음성,의원체내원성질립PCR검측양성,omp1-한제성편단장도다태성(RFLP)분형위L3형.Western인적시혈청사안의원체주요외막단백(MOMP)항체양성,다형외막단백H(PmpH)항체＞1:800,의원체다대배양양성.우복고구우상증생처활검시피부고분화린상세포암.진단:성병성림파육아종합병피부린상세포암.
A 53-year-old man was admitted to the hospital for verrucous hyperplasia on the circular sulcus for 2 years as well as erythematous painful swelling, ulcer and rupture of inguinal lymph nodes for more than 2 months. Physical examination revealed erythematous, indurated and painful swelling of bilateral inguinal lymph nodes. Fluctuation could be felt at the centre of the right swollen inguinal lymph nodes, where several pores were seen with yellowish-white purulent fluid flowing out, giving the appearance of a watering can. Multiple swollen or ulcerative lymph nodes were separated by the inguinal ligament forming the "groove sign".There were irregular, indurated, verrucous, proliferative and keratinized lesions sized 1 cm × 2 cm on both sides of the circular sulcus. The right scrotum was obviously swelling. Erythematous, fluctuating swelling, ulcer and rupture of the glans fraenum were also observed with yellowish-white purulent exudates. Neither the secretion from the skin lesions on the surface of bilateral inguinal lymph nodes nor the puncture sample from the right groin was positive for multiple fungal or bacterial culture, acid-fast stain or first culture of C. trachomatis.However, the endogenous plasmid of Chlamydia was successfully amplified by PCR from these samples, and restriction fragment length polymorphism (RFLP) analysis of the major outer membrane protein (MOMP) suggested that the genotype of the Chlamydia strain was L3. Western blot revealed the presence of anti-MOMP antibodies and anti-Pmp H antibodies (titer: ＞ 1: 800) in serum. Culture of C. trachomatis also gave positive results after multiple passage. Biopsy of the verrucous hyperplasia on the right groin is consistent with well-differentiated squamous cell carcinoma of the skin. A diagnosis of lymphogranuloma venereum complicated by cutaneous squamous cell carcinoma was made.