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病例男,3.5岁。入院前两天出现头痛、流涕、咳嗽、腹痛、呕吐、不适及嗜睡。手足发现斑丘疹,逐渐扩散至四肢并变为紫癜。入院前3个月,曾患A组β型溶血性链球菌性肛周蜂窝织炎,口服青霉素后消退,但新近复发。体检:头皮轻度水肿,紫癜,肛周红斑疹,右上腹稍压痛,左睾丸肿痛。血清钠126mEq/L,总蛋白4.9g/dl,白蛋白3 g/dl,白细胞17,770,血小板514,000/μl,肝功及脑脊液正常。仅肛周拭子培养生长A组β型溶血性链球菌。噻吩甲氧头孢菌素与氯霉素静脉滴点,各5及7天。入院2周,左膝及两臀部痛,频发腹痛,紫癜加剧,但肛周蜂窝织炎迅速消退。血清BUN、肌酸酐、尿肌酸酐廓清率及逐日尿分析正常。患儿轻至中度高血压,用巯甲丙脯酸后下降。曾口服甲基强的松龙3天。诊断过敏性紫癜(HSS)出院。出院后5天发
Male, 3.5 years old. Two days before admission, headache, runny nose, cough, abdominal pain, vomiting, discomfort and drowsiness. Hand-foot spot rash, gradually spread to limbs and become purpura. 3 months before admission, had a group of β-hemolytic streptococcal perianal cellulitis, oral administration of penicillin, but the recent relapse. Physical examination: mild scalp edema, purpura, perianal erythema, right lower quadrant tenderness, left testicular swelling and pain. Serum sodium 126mEq / L, total protein 4.9g / dl, albumin 3g / dl, white blood cells 17,770, platelets 514,000 / l, liver function and normal cerebrospinal fluid. Only perianal swabs were cultured to grow group A beta-hemolytic streptococcus. Thiophene methoxy cephalosporins and chloramphenicol intravenous drip point, each 5 and 7 days. Admission for 2 weeks, left knee and hip pain, frequent abdominal pain, purpura intensified, but perianal cellulitis quickly subsided. Serum BUN, creatinine, urine creatinine clearance rate and daily urine analysis were normal. Children with mild to moderate hypertension, with captopril after the decline. Had oral methylprednisolone 3 days. Diagnosis of Henoch-Schonlein Purpura (HSS) was discharged. Five days after discharge from the hospital