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患儿男,5岁,一月前因受凉后发烧,经各种抗菌素及激素等治疗,不见好转。一周后出现消瘦、食欲减退、腹胀、精神不振,时有烦躁不安,同时颜面出现多发性“软疣”样改变。因发烧不退,病情加重转入我科。查体:体温39.7℃,脉搏140次/分。呼吸43次/分,血压100/80毫米汞柱。急性热病容,烦躁不安,面部及躯干有散在性丘疹,表面结痂。面部还有散在软疣改变十余处。巩膜及皮肤无黄染,心肺无著变。腹部明显隆起,腹壁静脉扩张,全腹轻压痛,肝大肋下6厘米,剑突下8厘米,质较硬,无明显结节,轻触痛,脾脏左肋下3厘米,无触育,腹水征(+++)。化验:血红蛋白6.7克,红细胞226万/mm~3,白细胞2万/mm~3,中性80%,淋巴17%,酸性3%,血沉60mm/小时。尿粪常规(-),胸透无异常,OT及kaseni试验(-),多次血培养(-),肾功正常,肝功有明显损害。碱性(?)酶、胎甲球、火箭电泳均正常。超声及B型扇扫,见肝脾大,无液化区,肝扫描示弥漫性损害。骨髓检查为增生性骨髓象伴中毒性改
Children male, 5 years old, one month ago due to cold after a fever, after a variety of antibiotics and hormones and other treatment, did not improve. After a week of weight loss, loss of appetite, bloating, lack of energy, sometimes irritability, while the face appear multiple “soft warts” like change. Due to fever, disease progression into my department. Physical examination: body temperature 39.7 ℃, pulse 140 beats / min. Breathing 43 beats / min, blood pressure 100/80 mmHg. Acute fever, irritability, scattered face and trunk pimples, scabs on the surface. There are scattered in the face of soft warts change more than ten. Sclera and skin without yellow dye, no change in heart and lungs. Abdomen obvious bulge, abdominal veins dilatation, all abdominal mild tenderness, liver ribs 6 cm, xiphoid 8 cm, the quality of hard, no obvious nodules, touch the pain, the left splenic spleen 3 cm, Ascites sign (+++). Laboratory tests: Hemoglobin 6.7 grams, red blood cells 2.26 million / mm ~ 3, white blood cells 20,000 / mm ~ 3, 80% neutral, lymph 17%, acid 3%, ESR 60mm / h. Urine manure routine (-), no abnormal chest X-ray, OT and kaseni test (-), multiple blood cultures (-), normal renal function, liver function obvious damage. Alkaline (?) Enzyme, fetal ball, rocket electrophoresis are normal. Ultrasound and B-type fan scan, see the liver and spleen, no liquefaction area, liver scan showed diffuse damage. Bone marrow examination for hyperplastic bone marrow with toxic changes