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患者,男,47岁,农民,间断发冷发热5个月,恶心呕吐、头痛乏力4个月。1997年5月5日入院。体温达38℃以上,午后明显,无盗汗。吐白色粘液,伴少量咖啡样物,进食后加重。既往患“类风湿性关节炎”30年,一直服用正痛片、布洛芬等解热止痛药及强的松片治疗。20年前在轻微外力下双股骨骨折。夜尿开始增多。15年前发生急性腰疼,血尿1次,当时检查BUN、Scr已轻度增高。10年前出现贫血及血压增高。查体:慢性病容,贫血貌,皮肤干燥、粗糙。双肺呼吸音清,心界向左下扩大。肝脾未及,双肾区叩痛阳性,移动性浊音阴性。双下肢浮肿阴性。双足趾关节畸形,脊柱、右下肢活动受限。
Patient, male, 47 years old, farmer, intermittent chills and fever 5 months, nausea and vomiting, headache and fatigue for 4 months. May 5, 1997 admission. Body temperature up to 38 ℃, afternoon obviously, no night sweats. Spit white mucus, with a small amount of coffee-like substance, increased after eating. Past suffering from “rheumatoid arthritis” for 30 years, has been taking orthoptic tablets, ibuprofen and other antipyretic analgesics and prednisone treatment. Bone fracture under slight external force 20 years ago. Nocturia began to increase. 15 years ago, acute back pain, hematuria 1 time, then check BUN, Scr has been mildly increased. Anemia and blood pressure ten years ago. Physical examination: chronic disease, anemia appearance, dry skin, rough. Respiratory sound clear lungs, heart to the left to expand. Lack of liver and spleen, kidney area knocking pain positive, shifting voiced negative. Lower extremity edema negative. Dual toe joint deformity, spine, right lower extremity activity limited.