胃梅毒（GastricSyphilis）想到的

最近在《Th e New England Journal of Medicine》看到一篇文章：Gastric Syphilis。病情是这样的：A 32-year-old man presented to the internal medicine clinic with a 2-week history of epigastric pain, nausea, anorexia, and weight loss.Physical examination was notable for epigastric tenderness. A computed tomographic scan of the abdomen showed mural thickening of the gastric antrum.Endoscopy revealed an ulcer measuring 4.0 cm by 5.0 cm in the gastric antrum (Panel A) and an ulcer measuring 1.2 cm by 1.2 cm on the greater antral curvature (Panel B). Biopsy samples of the ulcers showed infiltration of lymphocytes, neutrophils,and plasma cells. There were no malignant features. Further history taking revealed that the patient had had a genital ulcer 1 month before presentation. A subsequent serum Treponema pallidum particle agglutination test was positive, and the rapid plasma reagin (RPR) titer was 1:128. Immunohistochemical staining of the ulcer-biopsy specimens for T. pallidum was positive (Panel C). Testing for the human immunodeficiency virus was negative. A diagnosis of gastric syphilis was made. Once-weekly injections of penicillin G benzathine were given for 3 weeks. Two weeks after the patient began treatment, his symptoms had abated. Four months after the completion of treatment, repeat testing showed that the RPR titer had decreased to 1:4, and a repeat endoscopy showed that the ulcers had resolved (Panel D, arrows).

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译文：一名32岁男性因上腹痛、恶心、厌食和体重减轻2周到内科门诊就诊。体格检查发现上腹压痛。腹部计算机断层扫描显示胃窦壁增厚。内镜检查：胃窦可见一4.0 cm x 5.0 cm溃疡（图A），胃大弯可见一1.2 cm x 1.2 cm溃疡（图B）。溃疡活检样本显示有淋巴细胞、中性粒细胞和浆细胞浸润，未见恶性特征。进一步追问病史，患者诉就诊前1个月曾罹患生殖器溃疡。随后进行的血清梅毒螺旋体颗粒凝集试验呈阳性，快速血浆反应素试验（RPR）滴度为1:128。溃疡活检标本的梅毒螺旋体免疫组化染色呈阳性（图C）。人类免疫缺陷病毒检测呈阴性。该患者诊断为胃梅毒，并接受苄星青霉素G注射治疗，每周一次，共3周。治疗开始两周后，患者症状有所缓解。治疗结束4个月后复查，RPR滴度降至1:4，复查内镜显示溃疡已愈合（图D，箭）。

  之前黄医生的科普文章曾多次提到梅毒可以侵犯身体的所有器官，所有胃梅毒的出现也不足为奇，查阅文献，之前国外文献就有许多有关胃梅毒的报道：

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• 这种情况可以通过血液散播感染，另外胃肠镜消毒不彻底也可以传染，20多年前黄医生就曾遇到一位这种途径感染梅毒的患者。

所以梅毒的危害还是比较大的，因此之前黄医生提出《何不来一次性病“体检”——敬告有过高危性行为的盆友》，还不能仅仅盯着身上是否有皮疹、生殖器上的异常。因为有多大三分之一的是隐性梅毒，加上这些类似胃梅毒这样的内脏梅毒，容易误导或者误诊，如果不及时发现梅毒，将错过最佳的治疗时机，祸害无穷。