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病历摘要患者男,19岁。因长期发热(体温38～40℃)伴反复发作性中上腹痛、水样便一年余。多家医院诊断为“胃肠炎”、“结肠炎”、“胆道疾病”,曾先后应用多种抗菌素和中药治疗,无效。近期高热不退,拟发热待查入院。患者生活在血吸虫病流行区,既往史、家族史无特殊。体检:体温39.8℃,呼吸120次,脉搏28次,血压90/60。神志清,轻度贫血貌,皮肤、粘膜无出血点及皮疹,浅表淋巴结不肿大,巩膜无黄染。心肺(-)。肝上界第五肋间,下界肋下1.5cm,质软。脾肋下6cm,质中,有压痛。腹部(-)。余皆正常。实验室检查:周围血象基本正常,尿蛋白少,大便常规(-),心电图(-),肝功能(-),超声波示脾肿大,血沉18mm/h,胸片示右上肺结核已钙化,肥达氏反应“O”1:640、“H”1:320,大便培养加找霉菌均(一),抗“O”500单位,乙状结肠镜(-),钡灌摄片(-),血堵养及骨髓培养均(-),骨髓象为感染象表现。入院后给予一般抗菌素加补液等治疗无效。再度作血与骨髓培养,发现四联球菌,药敏试验先锋霉素、P_(12)极度敏感。给予先锋霉素和P_(12)各4g静滴/日、强的松30mg/日,用药后体温有下降趋势,但反复较大。患者日趋消瘦,贫血加重。后又出现腹中部有一核桃大小肿块,疑为内脏淋巴瘤。此时患者病情恶化,出现暗红色便血,每次200～300ml,血压降至76/50。给予补液、输血等治疗,病情日益加重。
Patient summary Male, 19 years old. Due to long-term fever (body temperature 38 ~ 40 ℃) with recurrent mid-upper abdominal pain, water samples will be more than a year. Many hospitals diagnosed as “gastroenteritis”, “colitis”, “biliary disease”, has a variety of antibiotics and traditional Chinese medicine has been used to treat, ineffective. The recent high fever, intended to be admitted to hospital pending fever. Patients living in the endemic area of schistosomiasis, past history, family history no special. Physical examination: body temperature 39.8 ℃, 120 breaths, pulse 28 times, blood pressure 90/60. Consciousness, mild anemia appearance, skin, mucous membrane without bleeding and rash, superficial lymph nodes is not swollen, Sclera no yellow dye. Cardiopulmonary (-). The upper limit of the fifth intercostal space, the lower limit rib 1.5cm, soft. Spleen rib 6cm, quality, tenderness. abdomen(-). I am all normal. Laboratory tests: peripheral blood as normal, urinary protein, stool (-), electrocardiogram (-), liver function (-), ultrasound showed splenomegaly, erythrocyte sedimentation rate 18mm / h, (1), anti-O "500 units, sigmoidoscopy (-), barium perfusion film (-), blood block Breeding and bone marrow culture were (-), bone marrow as infection-like performance. Admission to the general antibiotic plus fluid treatment is invalid. Once again for blood and bone marrow culture, found that four strains of bacteria, drug susceptibility test cephalosporins, P_ (12) extremely sensitive. Given celecoxib and P_ (12) each 4g intravenous infusion / day, prednisone 30mg / day, after treatment, body temperature decreased, but repeated larger. Patients are getting thinner, anemia increased. Appeared after the middle of a walnut-sized lumps, suspected visceral lymphoma. At this point the patient’s condition deteriorated, there dark red blood in the stool, each 200 ~ 300ml, blood pressure dropped to 76/50. Give rehydration, blood transfusions and other treatment, the condition is getting worse.