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患者,女性,63岁,因发热腰酸痛4天,全身皮疹、少尿、水肿2天于1992年1月6日入院。入院前1周因“上呼吸道感染”经用氨苄青霉素(4g/日)治疗后呼吸道症状消失。用药后第4天出现发热、腰酸痛,拟诊“尿路感染”继续用氨苄青霉素2天后,全身出现红色皮疹并感瘙痒,同时伴有少尿、颜面水肿、恶心、呕吐,四肢关节疼痛,以双膝关节为主,且逐渐加重急诊入院。查体:T38.6℃,Bp18/12kPa,神志清楚,全身皮肤散在红色丘疹,部分区域密集成片,颜面水肿,心肺正常,腹软,肝脾未扪及,移动性浊音阴性。双肾压叩痛。双膝关节红、肿、热、触痛,活动受限,双下肢凹陷性水肿。实验室检查:WBC12.4×19~9/L嗜酸性粒细胞12％。尿蛋白(++),尿沉渣瑞氏染色见大量嗜酸性粒细胞。CO_2CP15.9mmol/L,BUN37.2 mmol/L,Scr 877μmol/,考虑氨苄青霉素过敏所致急性间质性肾炎(AIN),停用氨苄青霉素,并给糖皮质激素、速尿、必需氨基酸,大黄等中药保留灌肠等治疗。7天后皮疹、水肿消退,恶心、呕吐缓解,尿量增多,
Patient, female, 63 years old, 4 days due to fever, back pain, systemic rash, oliguria, edema 2 days admitted on January 6, 1992. One week prior to admission, respiratory symptoms disappeared after treatment with “upper respiratory tract infection” with ampicillin (4 g / day). On the fourth day after treatment, fever and backache were found. After being diagnosed with “urinary tract infection” for 2 days, ampicillin was given for 2 days. A red rash and pruritus appeared on the body and accompanied by oliguria, facial edema, nausea and vomiting, joint and joint pain, The main knees, and gradually increase emergency admission. Physical examination: T38.6 ℃, Bp18 / 12kPa, conscious, the whole body scattered red papules, dense areas into pieces, facial edema, normal heart and lungs, abdominal soft, liver and spleen are not palpable, shifting voiced negative. Kidney pressure percussion pain. Double knees red, swollen, hot, tenderness, limited mobility, depression of both lower extremity edema. Laboratory tests: WBC12.4 × 19 ~ 9 / L eosinophils 12%. Urine protein (++), urinary sediment Wright’s stain see a large number of eosinophils. CO_2CP15.9mmol / L, BUN37.2mmol / L, Scr 877μmol /, considering ampicillin hypersensitivity caused by acute interstitial nephritis (AIN), disable ampicillin, and glucocorticoid, furosemide, essential amino acids, rhubarb Such as Chinese medicine retention enema and other treatment. 7 days after the rash, edema subsided, nausea, vomiting relief, increased urine output,