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患者 男性,20岁。主因进行性突眼1个月,发热5天入院。查体:全身皮肤无黄染及出血点,双手掌及足心可见散在环形红斑,压之退色。右颌下、右腋下及双侧腹股沟可触及数个蚕豆大淋巴结,质地中等,无触痛。双眼球明显前突,以右眼为甚,双眼视力1.5,眼底检查未见异常。胸骨压痛。肝、脾肋下未触及。神经系统检查未见异常。血象:Hb 94g/L,WBC 44.0×10~9/L,原始粒细胞+早幼粒细胞0.93,PC 22.4×10~9/L。骨髓原始粒细胞0.054,早幼粒细胞0.588。诊断为急性非淋巴细胞白血病(ANLL),M_(2)a型。脑脊液检查:初压1.57kPa(160mmH_2O),蛋白3.0g/L,白细胞总数2.0×10~9/L,幼稚细胞0.94,符合中枢神经系统白血病(CNSL)诊断标准。
Male patient, 20 years old. Mainly due to progressive exophthalmos 1 month, fever 5 days admitted. Physical examination: systemic skin without yellow dye and bleeding points, both hands and palpable heart scattered scattered ring erythema, pressure of the fade. Right mandible, right axillary and bilateral inguinal can reach several large beans, large, medium texture, no tenderness. Prominent bilateral protrusion of the eye, the right eye is even more binocular visual acuity 1.5, fundus examination showed no abnormalities. Sternal tenderness. Liver, spleen ribs untouched. Nervous system examination showed no abnormalities. Blood: Hb 94g / L, WBC 44.0 × 10 ~ 9 / L, the original granulocyte + promyelocytic 0.93, PC 22.4 × 10 ~ 9 / L. Bone marrow myeloid 0.054, promyelocytic 0.588. Diagnosis of acute non-lymphocytic leukemia (ANLL), M_ (2) a type. Cerebrospinal fluid examination: The initial pressure 1.57kPa (160mmH2O), protein 3.0g / L, the total number of leukocytes 2.0 × 10 ~ 9 / L, naive cells 0.94, in line with the diagnostic criteria of central nervous system leukemia (CNSL).