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例1,男性,59岁。1991年5月28日入院。患者于80d前受凉后发热,体温38.5～39.5℃,咳嗽,咳白色粘痰,偶有咯血,伴乏力、关节痛。在外院按肺部感染先后应用青霉素、氨苄青霉素、头孢唑啉等无效。查体:T38.5℃,右肺背部可听到湿罗音,心脏及腹部(-)。实验室检查:血、尿、粪常规(-),肝、肾功能均正常;ESR48mm/h;血、痰普通培养各3次均(-),ECG和骨髓检查均正常;X线胸片示右肺下野6cm×4cm片状非均质性模糊阴影,边界不清晰。胸部CT扫描提示右肺下叶炎性改变。纤维支气管镜(FB)检查:支气管系统未见异常,支气管粘膜刷片找抗酸菌(-)。入院后按肺炎给予头孢呋肟和甲硝唑治疗7d,体温仍波动在38.5～40℃,且胸片病灶略有增大。即按肺结核
Example 1, male, 59 years old. May 28, 1991 admitted to hospital. Patients in the 80d before the onset of fever, body temperature 38.5 ~ 39.5 ℃, cough, cough white phlegm, occasional hemoptysis, with fatigue, joint pain. In accordance with the pulmonary infection in the outer court has penicillin, ampicillin, cefazolin invalid. Physical examination: T38.5 ℃, wet rales can be heard on the back of the right lung, heart and abdomen (-). Laboratory tests: blood, urine and feces routine (-), liver and kidney function were normal; ESR48mm / h; blood and sputum common culture three times each (-), ECG and bone marrow examination were normal; Squamous 6cm × 4cm patchy heterogeneous fuzzy shadow, the border is not clear. Chest CT scan prompted changes in the right lower lobe inflammatory. Fiberoptic bronchoscopy (FB) check: no abnormal bronchial system, bronchial mucosal brush to find acid-fast bacteria (-). After admission to give cefuroxime and metronidazole pneumonia treatment 7d, the body temperature still fluctuate at 38.5 ~ 40 ℃, and a slight increase in chest X-ray lesions. That by tuberculosis