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患者,男,30岁。于入院前17个月渐觉双下肢酸痛无力,以上下坡时为阴显,逐渐出现两腿沉重,行走不稳,消瘦,且进行性加重。至入院前8个月不能站立,双手丧失持物能力,言语缓慢,房事不能,双下肢肿胀,皮肤干燥增厚。入院前一个月觉腹胀,食欲减退.体查:T36.5℃Bp 16/8.78kPa 慢性消瘦病容。全身皮肤干燥增厚,色素沉着,可见片状脱屑,以四肢为明显.双踝以下凹陷性水肿.肝区叩痛,腹水征阳性.神经系统检查;双侧视乳头水肿,面部痛觉过敏.四肢肌张力减低,肌萎缩,肌力Ⅲ度,双踝肌力0～Ⅰ度。双足内翻.腱反射减低,跟腱反射消失.全身对称性痛觉过敏,双膝以下触觉减退.病理征(一)。骨髓涂片:浆细胞嗜碱
Patient, male, 30 years old. 17 months before admission, gradually lower extremity pain and weakness, overhill when the overcast, gradually heavy legs, walking unsteadiness, weight loss, and progressive increase. To 8 months before admission can not stand, his hands lose the ability to hold things, speech is slow, can not be room, both lower extremities swelling, thickening of the skin dry. One month before hospitalization, we feel bloating and loss of appetite. Physical examination: T36.5 ℃ Bp 16 / 8.78kPa Chronic weight loss. Dry skin thickening, pigmentation, visible flake scaling, to the limbs as obvious .Aucky ankle below the edema .Photogenic liver area, positive ascites .Neurological examination; bilateral papilledema, facial hyperalgesia. Limb muscle tension decreased, muscle atrophy, muscle strength III, muscle strength 0 ~ Ⅰ degree. Bipedal varus tendon reflexes, Achilles tendon reflexes disappeared Symptoms of systemic symmetry hyperalgesia, tactile hypotonia below the knees Pathological sign (a). Bone marrow smear: plasma cells basophilic