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患者女性、36岁,因畏寒、发热、周身疼痛(以腓肠肌为著)伴胸闷、气急、心悸、指关节红肿半月于1989年6月12日入院.病后第3天当地诊为“风湿热”予大剂量青霉素、激素、阿斯匹林治疗,第9天症状缓解而停用激素,第10天发现颜面、躯干皮肤潮红,有丘疹及斑丘疹,无搔痒感,第11天再次发热,体温高达40℃,并伴右上腹疼痛.门诊拟诊胆道感染、败血症入院.既往无结核、肝炎、风湿病史,无药物过敏史,无疫水接触史.体检:T37.5℃,P68次/分,R18次/分,BP19.19/11.73kPa.全身皮肤见猩红热样皮疹和斑丘疹.全身浅表淋巴结黄豆至蚕豆大小,入院后左腋窝2颗淋巴结增至2×1.5cm,质较软,无压痛,无粘连.眼球结膜充血,心肺听诊正常.腹软,肝肋下1.5cm,质软,右上腹压痛,肾区叩痛阳性.血RBC3.79～4.2×10~(12)/L,Hb108～120g/L,
Female patient, 36 years old, was admitted to hospital on June 12, 1989 due to chills, fever, whole body ache (gastrocnemius) accompanied by chest tightness, shortness of breath, palpitations, and joint swelling. Rheumatic fever "to large doses of penicillin, hormones, aspirin treatment, the symptoms were relieved on the 9th day and stop using hormones, the first 10 days found face, body skin flushing, pimples and rash, no itching sensation, the first 11 days Fever, fever, body temperature up to 40 ° C, and with right upper quadrant pain .Budget clinic suspected biliary tract infection, sepsis admitted .No tuberculosis, hepatitis, history of rheumatism, no history of drug allergy, no contact with water history. Physical examination: T37.5 ℃, P68 beats / min, R18 beats / min, BP19.19 / 11.73kPa. Scarlet-like skin rashes and rash on the whole body. Whole body superficial lymph nodes from soybeans to broad bean size, left axillary lymph nodes increased to 2 × 1.5cm, Soft, tenderness, no adhesions. Eye conjunctival hyperemia, cardiopulmonary auscultation normal. Abdominal soft, liver ribs 1.5cm, soft, right upper quadrant tenderness, kidney area knocking positive. Blood RBC3.79 ~ 4.2 × 10 ~ ( 12) / L, Hb 108 ~ 120g / L,