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患者男,49岁,发热伴乏力、腰痛10天,加重1周拟发热待查入院.10天前,患者无明显诱因而出现发热(T38℃),伴腰部酸痛、全身乏力、无咳嗽、咳痰、尿痛、消瘦、纳差、黑粪等临床表现.体检:T37.4℃,神清,浅表淋巴结无肿大,心肺无异常发现,腹软,肝肋下一指,脾肋下未及,右肾区叩痛(+).拟诊为肾周脓肿.先后给予头孢他啶、泰能抗感染治疗,但体温未见下降.实验室检查示:血常规WBC10.4×10~9/L,NO.75,Hb114g/L,PLT10l×10~9/L;尿粪常规及隐血阴性;肝、肾功能正常;嗜酸性粒细胞数:3200×10~6/L;血沉:22mm/h;CEA 2.4μg/mL,AFP1.10μg/mL,CA1257.6lng/mL;IgG11.5g/L,IgA 2.33g/L,IgM0.54g/L,IgE5.054μg/L;HBsAg(+),HBeAg(+),HBcAb(+);骨髓涂片:嗜酸性粒细胞增多骨髓像0.284,早幼0.012、晚幼0.024、带形核0.104、分叶核0.144;寄生虫学检查:旋毛虫、肺吸虫及华支睾吸虫循环抗体(一);X线胸片(一);腹部CT:两下胸腔少许积液,局部胃壁较厚;胃镜:胃体中部后壁巨大隆起溃疡性病变,蠕动差,易出血,边缘显示不规则,结节样隆起,可见陈旧性出血,十二指肠球部至降部前段见大块隆起,表面糜烂出血,十二指肠壁僵直,活动差.病理:十二指肠球部低分化腺癌,胃体部印戒细胞癌;兔疫酶标:CA(+),EMA(+),LCA(-),L26(-),VchL1(-).患者于入院?
Patient male, 49 years old, with fever, fatigue, low back pain for 10 days, an increase of 1 week to be investigated for admission to the hospital. 10 days ago, the patient had no obvious inducement and fever (T38 °C), accompanied by low back pain, general malaise, no cough and expectoration. Clinical manifestations such as spasticity, dysuria, emaciation, anorexia, and black feces. Physical examination: T37.4°C, Shenqing, superficial lymph nodes without enlargement, no abnormalities in heart and lung, abdominal softness, liver ribs, spleen In the past, the right kidney area was painful (+). It was diagnosed as a perirenal abscess. Ceftazidime and Taieneng were given anti-infective treatment, but the body temperature did not decrease. Laboratory tests showed that blood routine WBC10.4×10~9/ L,NO.75,Hb114g/L,PLT10l×10~9/L; Urine excrement routine and occult blood negative; Liver, renal function normal; Eosinophils: 3200×10~6/L; ESR: 22mm/h CEA 2.4μg/mL, AFP1.10μg/mL, CA1257.61ng/mL; IgG11.5g/L, IgA 2.33g/L, IgM0.54g/L, IgE5.054μg/L; HBsAg(+), HBeAg ( +), HBcAb (+); bone marrow smear: eosinophilia bone marrow image 0.284, early childhood 0.012, late young 0.024, banded nucleus 0.104, lobular nucleus 0.144; parasitological examination: Trichinella, Pneumophila and Clonorchis circinate antibody (I); X-ray chest X-ray (A); Abdomen CT: a little effusion in two thoracic cavity, local stomach wall Thick; Gastroscope: Large ulceration of the posterior wall of the stomach, ulceration, poor peristalsis, easy bleeding, irregular edges, nodular uplift, visible old bleeding, duodenal bulb to see the large section of the anterior segment of the descending section , Surface erosion, duodenal wall stiffness, poor activity. Pathology: Duodenal differentiated adenocarcinoma, gastric signet ring cell carcinoma; rabbit disease enzyme standard: CA (+), EMA (+) Patients with LCA(-), L26(-), VchL1(-).