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病历摘要 患者,男,32岁,在苏丹工作1年余。于1991年11月16日以寒战、高热半天之主诉收住中国驻苏丹医疗队。入院时精神可,体温40.3℃,疟原虫检测阳性,按疟疾常规治疗,3d后体温仍40.3℃,呈间歇性,午后加重,伴寒战,大汗,查血象WBC 30.8×10~9/L,分叶核细胞85％,疟原虫检测仍阳性,X线胸片未见异常。拟诊:①耐氯喹疟原虫感染,②疟疾合并感染待查。改用肌注蒿甲醚,同时静点氨苄青霉素,3d后体温39.8℃左右,查体脾肋下1.5cm,质软,有压痛,疟原虫检测阴性,WBC 28×10~9/L,分叶核97％,骨髓穿刺检查提示“感染骨髓象”,B超提示“脾下端被膜下有一局限的外伤性血肿,脓肿?肝、胆、胰、肾未见异常。”追问病史患者于4月前左上腹被击一拳,当时无任何不适,近2月来左上腹一直不适,胀疼。根据以上情况考虑“脾脓肿”,加用先锋Ⅳ 4g/d,TMP 0.4g/d,体温渐下降,于病程20d体温37.2℃回国诊治。在北京友谊医院行脾B超、CT、同位素检查,均示“脾脓肿”,脾2/3坏死:奇生虫试验均阴性,后行脾切除术。
Patient summary, male, 32 years old, working in Sudan for more than 1 year. On November 16, 1991, with the chief complaint of the chills and fever, they accepted the Chinese medical team in Sudan. On admission psychosis, body temperature 40.3 ℃, Plasmodium test positive, according to the conventional treatment of malaria, 3d body temperature is still 40.3 ℃, was intermittent, afternoon aggravating, accompanied by chills, sweating, check the blood like WBC 30.8 × 10 ~ 9 / L, 85% of lobular cells, malaria parasite test is still positive, no abnormal chest X-ray. To be diagnosed: ① resistant to chloroquine-resistant Plasmodium infection, ② malaria infection to be investigated. Switch to intramuscular artemether, ampicillin at the same time static point, body temperature 39.8 ℃ after 3d, check the spleen ribs 1.5cm, soft, tenderness, negative for Plasmodium test, WBC 28 × 10 ~ 9 / L, points 97% of the leaf nucleus, bone marrow biopsy prompted “infected bone marrow like” B ultrasound prompts “a limited area under the capsule of the spleen traumatic hematoma, abscess? Liver, gallbladder, pancreas, kidney no abnormalities.” Patients with history asked in April Before the left upper quadrant was hit a punch, then without any discomfort, the last two months left upper quadrant has been discomfort, swelling pain. According to the above situation to consider “spleen abscess”, plus avant-garde Ⅳ 4g / d, TMP 0.4g / d, body temperature gradually decreased in the course of 20d body temperature 37.2 ℃ return diagnosis and treatment. In Beijing Friendship Hospital line splenic B, CT, isotope examination, all showed “spleen abscess”, 2/3 of the spleen necrosis: the test was negative for all odd spiders, followed by splenectomy.