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患者男,52岁,因咳嗽,咳痰3月余,加重5d,于1993年10月25月入院。患者3月前无明显诱因出现低热(37～38℃)咳嗽,咳痰。痰色白粘稠,无咳血及胸痛,在门诊按“肺炎”用抗生素治疗无效,入院5d前剧咳,气短,活动后加重,有“类风湿关节炎”史已4年。T 37.2℃,P 124min~(-1),R 23min~(-1),BP 16/10 kPa,精神差,双肺呼吸音低,可闻及细小水泡音,心(-),肘关节周围可见两个皮下结节。四肢关节无肿痛。Hb 109 g/L,RBC 4.5×10~(12)/L,WBC 7.0×10~9/L,N 0.70,L 0.27,E 0.03,尿(-),ESR 103mm/h,ASO(-),RF阳性,IgG 5.2g/L,IgA 0.6g/L,IgM 2.03g/L,痰抗结核抗体阴性,OT(-),痰查结核菌(-),ECG示窦性心动过速。胸片示:双肺下见片絮状阴影,肋膈角模糊。气管镜见镜下支气管有炎症改变。入院诊断:双肺肺炎,肿结核不除外,予以抗痨剂及磷霉素、甲硝唑
Male patient, 52 years old, due to cough, sputum more than 3 months, increased 5d, admitted in October 1993 October 25. Patients with no obvious incentive 3 months ago, fever (37 ~ 38 ℃) cough, sputum. Sputum color white viscous, coughless blood and chest pain in the clinic by “pneumonia” with antibiotic therapy ineffective, admitted to the hospital 5d before cough, shortness of breath, aggravating after activity, “rheumatoid arthritis” history has been 4 years. T 37.2 ℃, P 124min ~ (-1), R 23min ~ (-1), BP 16/10 kPa, poor spirit, low breath sounds of both lungs, Two subcutaneous nodules can be seen. Limbs and joints without swelling and pain. Hb 109 g / L, RBC 4.5 × 10-12 / L, WBC 7.0 × 10-9 / L, N 0.70, L 0.27, E 0.03, urinary ESR 103 mm / h, ASO RF positive, IgG 5.2g / L, IgA 0.6g / L, IgM 2.03g / L, sputum anti-TB antibody negative, OT (-), sputum check TB (-), ECG showed sinus tachycardia. Chest X-ray showed: under the lungs see film flocculus shadow, costophrenic angle blurred. Bronchoscopy bronchoscopy to see the inflammation changes. Admission diagnosis: double lung pneumonia, swollen tuberculosis is not excluded, given anti-tuberculosis agents and fosfomycin, metronidazole