论文部分内容阅读
患者 男,58岁。因间歇畏寒发热2月余,在外院疑伤寒给予氯霉素1.5g/d静滴治疗10天无效,于1993年2月5日入院。查体:体温39℃,全身浅表淋巴结未扪及,双肺呼吸音清,腹软,肝脾未及,未扪及包块,无压痛和反跳痛。查三大常规、血培养、血胆汁培养、肥达氏反应正常,抗核抗体阴性,骨髓涂片正常;肝胆脾胰B超及上腹部CT检查正常,X线胸片正常。拟诊为结缔组织病,肿瘤待排,但一直未找到证据。入院第12天,患者右下腹深压痛,无反跳痛,未扪及包块。全消化道钡餐提示慢性阑尾炎。于是按阑尾炎给予庆大毒素16万U,灭滴灵1.5g/d静滴治疗7天无效。为除外肠结核,又给予HRE诊断性治疗1月无效。入院第52日,患者突发
Male patient, 58 years old. Due to intermittent chills and fever for more than two months, in the external hospital suspected typhoid fever chloramphenicol 1.5g / d intravenous infusion treatment for 10 days invalid, was admitted on February 5, 1993. Physical examination: The body temperature was 39°C. The whole body had no lymph node metastasis, and the lungs had clear breath sounds, soft abdomen, no liver and spleen, no palpable masses, and no tenderness or rebound tenderness. Check the three major conventional, blood culture, blood bile culture, normal Wada reaction, anti-nuclear antibody negative, normal bone marrow smear; liver and gallbladder spleen and pancreas B and upper abdomen CT examination was normal, X-ray normal. He was diagnosed with connective tissue disease. The tumor was to be discharged but no evidence had been found. On the 12th day of admission, the patient had deep tenderness in the right lower quadrant, no rebound tenderness, no palpitation, and mass. Full digestive barium meal prompted chronic appendicitis. So, according to appendicitis, Qing Toxin was given 160,000 U, and metronidazole 1.5 g/d was ineffective for 7 days. In addition to intestinal tuberculosis, HRE diagnostic treatment was invalid for one month. On the 52nd day of admission, the patient suddenly