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患者,女性,34岁,于1990年2月17日在普鲁卡因局麻下行阑尾切除术。术后持续寒战2h,开始发热,呈持续性,体温波动于37.8℃～41.2℃之间。高热时伴有头痛、头晕、轻度刺激性干咳,双膝、髋、肘、肩关节疼痛;低热时上述症状亦随之减轻,皮肤瘙痒。于3月9日胸背部出现粟粒大小红色丘疹,部分融合成片,无季肋部胀痛。抗风湿、抗感染3个月无效,于6月17日入院。查体:体温38℃,神清,精神状态良好,躯干部散在红色斑丘疹,全身浅表淋巴结均肿大,最大直径2.5cm,光滑、活动、无压痛。心肺无异常,腹软,肝脏未触及,脾脏肋下3.6cm,表面光滑,边缘稍钝,质地中等度硬,无压痛。关节无红肿,活动不受限。胸部X线检查:肺纹理增强。心电图正常。血红蛋白115g/L,白细胞7.7×10~9/L,血沉76mm/h,A/G为32/33(g/L)。蛋白电泳:A,57,α_10.022,α_20.087,β0.111,
The patient, female, 34 years old, underwent appendectomy on local anesthesia with procaine on February 17, 1990. Postoperative chills 2h, began to fever, was persistent, body temperature fluctuations between 37.8 ℃ ~ 41.2 ℃. High fever accompanied by headache, dizziness, mild irritating dry cough, knees, hips, elbows, shoulder pain; low fever, the above symptoms are also reduced, the skin itching. Miliary size red papules appeared on the back of the thorax on March 9, and some were integrated into a patch with no septal tenderness. Anti-rheumatic, anti-infective 3 months invalid, admitted on June 17. Physical examination: body temperature 38 ℃, Shen Qing, good mental state, the body scattered in red rash, systemic superficial lymph nodes are swollen, the maximum diameter of 2.5cm, smooth, activity, no tenderness. No abnormal heart and lung, abdominal soft, the liver has not touched, the spleen ribs 3.6cm, smooth surface, slightly blunt edge, the texture is medium hard, no tenderness. Joint no swelling, activity is not limited. Chest X-ray examination: enhanced lung markings. Normal ECG. Hemoglobin 115g / L, white blood cells 7.7 × 10 ~ 9 / L, erythrocyte sedimentation rate 76mm / h, A / G 32/33 (g / L). Protein electrophoresis: A, 57, α_10.022, α_20.087, β0.111,