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患者男,12岁,于1992年2月17日入院.2月前无明显诱因下感到腰背部疼痛伴发热,躯干不能弯曲.当地医院诊为“败血症”而以抗生素治疗,无明显效果,仍有发热,T39.8℃,伴右臀部针刺样疼痛,转上级医院诊为“骨髓炎,肿瘤?”,因“骨穿失败”未作定论.经菌必治、丁胺卡那、消炎痛等治疗后,体温正常,骨痛消失,且能下床活动.13天前突然两下肢瘫痪,二便失禁,伴发热,遂来诊.发病半年前在右大腿内侧出现一无痛、无痒的小块.体检:一般情况差,心肺无殊,肝脾未及.T_(7,8)以下感觉消失.两下肢运动障碍,无肌萎缩,皮温正常.T_(4～8)棘突压痛.右大腿内侧一肿块约鸡蛋大小,局部皮肤无异常改变,活动,质韧,无压痛,边界清.核磁共振检查:T_(4～8)椎体骨质破坏变扁.病理检查:右大腿肌肉恶性淋巴瘤.血常规:Hb87g/L,WBC13.0×10~9/L,NO.71,杆状核0.06,LO.21,MO.01,EO.01.血小板数118×10~9/L.白蛋白24g/L,球蛋白22g/L,白/球=1.09.
The male patient, 12 years old, was admitted to hospital on February 17, 1992. He felt low back pain and fever with no obvious incentives before February. The trunk could not be bent. The local hospital diagnosed as “septicemia” and treated with antibiotics had no significant effect. There is fever, T39.8 °C, with acupuncture-like pain in the right hip, transferred to the superior hospital diagnosed as “osteomyelitis, tumor?”, because of “bone puncture failure” is not conclusive. Bacterium rule, albuterol, anti-inflammatory After pain and other treatment, the body temperature is normal, bone pain disappears, and can get out of bed. 13 days ago suddenly two lower limb paralysis, two stools incontinence, with fever, palpitations came to the clinic. Six months before the onset occurred in the right thigh painless, no Itching small pieces. Physical examination: General poor, no cardiopulmonary, no liver and spleen. T_ (7,8) below the feeling of loss. Two lower limb movement disorders, no muscle atrophy, normal skin temperature. T_ (4 ~ 8) spines Sudden tenderness. A lump in the medial right thigh is about the size of the egg, no abnormal changes in the local skin, activity, quality, toughness, no tenderness, clear boundary. MRI: T_(4 ~ 8) vertebral bone destruction flattened. Pathological examination: Right thigh muscle malignant lymphoma. Blood routine: Hb87g/L, WBC13.0×10~9/L, NO.71, rod-shaped nucleus 0.06, LO.21, MO.01, EO.01. Platelet count 118×10 ~9/L. Albumin 24g/L, Protein 22g / L, albumin / globulin = 1.09.