布鲁氏菌病误诊慢性活动性肝炎1例分析

目的报告此病例,主要是分析布鲁氏菌病误诊为慢性活动性肝炎的原因。方法通过临床症状和体征、流行病学和实验室检查结果进行综合评价和分析,做出正确的诊断。结果该病例诊断为布鲁氏菌病。结论通过对布鲁氏菌病误诊原因分析,能为临床医生对布鲁氏菌病诊断提供经验。     

水貂养殖员布鲁氏菌病1例报告

本文报告了1例水貂养殖员布病患者。患者发烧,最高体温39.7℃,伴有乏力、身困、食欲不振,常大汗淋漓,关节疼痛不明显。经询问病史得知患者发病前经常接触病死羊羔,血检布病虎红平板凝集抗原和布病试管凝集抗原均阳性,确诊该患者为布鲁氏杆菌感染。经布病的对症治疗和抗菌治疗,患者痊愈出院。布病健教对象应扩大范围,同时应做好高危人群的监测工作。     

肺吸虫病误诊1例

本文报告肺吸虫病误诊1例。经血清学和病原学检查确诊后给予吡喹酮治疗，痊愈出院。     

胃癌误诊为成人Still病1例报告

患者女 ,6 4岁 ,因纳差 ,乏力 ,面色苍白 2年余 ,多次查血常规示贫血 ,但诊断不清 ,疗效不佳于 2 0 0 2年 8月 8日由当地医院转入我院。患者 2个月前因不规则发热 ,伴全身疼痛 ,眩晕 ,恶心 ,在当地医院查血 WBC 2 0 .1× 10 9/ L ,N 0 .85～0 .92 ,两次骨髓细胞学检查示感染骨髓像和小细胞低色素贫血 ,请某上级医院会诊 ,拟诊为成人 Still病。应用非甾体抗炎药及雷公藤片治疗 3天 ,出现黑便 ,贫血发展为重度。入院查体 :T 37.3℃ ,P 10 6次 / m in,R 19次 / min,Bp12 2 / 90 mm Hg1mm Hg≈ 0 .133k Pa)。营养尚好。皮肤粘膜苍白 ,无出…     

急性期布鲁氏菌病误诊为病毒性心肌炎1例

布鲁氏菌病（简称布病）临床表现多种多样，很容易与其他疾病混淆，造成误诊，甚至延误治疗，使病情加重或转为慢性。为了给更多的临床医师提供参考，现将1例急性期布病误诊为心肌炎作如下分析。     

布鲁菌病误诊为睾丸结核1例

患者男性,43岁,汉族,已婚,农民,河北赤城县人。主诉发热、乏力、关节疼痛2个月,阴囊肿痛、双下肢疼痛10d于2006年11月30日就诊。患者持续发热,体温达38．5℃,伴明显乏力、多汗,夜间为著,咳嗽及咯痰;双侧膝关节、踝关节疼痛,呈游走性,关节无红肿及活动障碍。发病以来食欲减退,体重明显下降。近10d症状加重,体温最高达39．5℃,伴寒战、头痛,双下肢剧烈疼痛,并出现阴囊肿大疼痛,以右侧为著,右侧腹股沟可触及两枚约0．5×0．7cm大小淋巴结,无压痛,B超检查提提示;右侧睾丸增大,     

急性布鲁氏菌病误诊为血液病5例临床分析

布鲁氏菌病（布病）是一种人畜共患性疾病．由于其临床表现变化多端．早期容易误诊。我科自2003年8月-2006年12月诊治5例．在院外或我院首诊时均误诊为血液病．现分析如下。     

成人Still病误诊为肝脓肿1例报告并文献复习

成人Still病是一种以发热、畏寒、皮疹、关节肿痛、外周血白细胞增多、脾肿大等为主要临床表现的全身性疾病,目前其发病机制不详[1]。由于成人Still病缺乏早期特异性症状、体征,非专科医师对该病的认识有限,临床易出现误诊、误治,导致延误病情。笔者近期收治1例成人Still病误诊为肝脓肿的患者,报道如下。     

多发性肌炎引起扩张型心肌病1例误诊病例分析

1病例资料患者,女,40岁,因"四肢肌肉疼痛,伴膝关节活动障碍1个月余"于风湿免疫科住院治疗。患者入院前1个月余出现四肢肌肉酸痛,膝关节轻度活动障碍,双下肢感乏力。既往史无特殊。入院查体:体温36.3℃,呼吸20次/min,心率67次/min,血压90/50 mm Hg(1 mm Hg=0.133 k Pa)。全身皮肤黏膜无黄染,浅表淋巴结未扪及肿大,双侧瞳孔等大等圆,对光反射灵敏,颈部活动稍受限,无抵抗,双肺呼吸音清,未闻及明显干湿啰音,心率67次/min,心律齐,心界叩诊偏大,各瓣膜听诊区未闻及明显病理性杂音,腹平软,无压痛、反跳痛及腹肌紧张,肝脾未扪及肿大。     

肺放线菌病1例报道及误诊原因分析

目的 探讨放线菌病的临床特征、影像学表现及误诊原因.方法 报道1例胸型放线菌病,并结合文献,总结放线菌病的临床特征、影像学表现,对误诊原因进行系统分析.结果 胸型放线菌病发病率低,临床医师认知较少,极容易误诊,主要引起误诊的原因为临床表现普通,影像学表现多样,放线菌标本取材困难,疗效判断周期长.为此,应该提高临床医师对本病的认识,同医技科室多交流,进行厌氧菌培养及特殊染色,提高诊断正确率,减少误诊.结论 放线菌病是一种少见病,临床上容易误诊,如果能够做到早诊断并提高综合治疗方案,预后良好.     

Pulmonary involvement in childhood brucellosis: a case report

Brucellosis is primarily a zoonotic disease that continues to be an important public health problem. It is a rare, multisystem infection of childhood and it may present with a wide spectrum of clinical presentations and complications. However, lung involvement is extremely rare in the course of childhood brucellosis. This case report describes a 6-year-old child who was referred to our hospital as meningococcemia but diagnosed as lobar pneumonia in follow-up. Brucella agglutination test and bone marrow culture were diagnostic of brucellosis. The patient responded to the combination therapy of rifampicin and trimethoprim-sulfamethoxazole.     

Clinical human brucellosis in Malaysia: a case report

Clinical human brucellosis is quite rare in Malaysia although seroconverters are relatively more. This report describes a case of clinical human brucellosis in Malaysia. This case involved a 29-year-old research assistant in a veterinary microbiology laboratory. She complained of intermittent fever, anorexia, profuse sweating, malaise, headache, normotensive (110/60 mm Hg), muscle pain, and arthralgia for 3 d. Blood tests against dengue and malaria were negative thus she was prescribed vitamin C, paracetamol and cough syrup for common flu. The complaints, however, persisted on and off for the next 1 month. She eventually developed anemia and hypotension (90/50 mm Hg) and started to show reduced body weight. Abdominal palpations revealed hepatomegaly and splenomegaly with pain. Thus, brucellosis was suspected before the Rose-Bengal plate test was performed, which revealed the presence of high level of antibody against Brucella. The same test was repeated after 14 d and the results confirmed the presence of high antibody level against Brucella. Following serum agglutination test, a diagnosis of brucellosis was made and she was eventually prescribed rifampicine p.o. once a day combined with doxycycline p.o. twice a day for 6 consecutive weeks before she made a full recovery.     

Hypothyroidism due to hepatic hemangioendothelioma: a case report

Although hemangioendothelioma (HHE) is a commonly encountered hepatic tumor during infancy, HHE−related hypothyroidism is rare. We present a patient who developed HHE−related hypothyroidism during the neonatal period and showed marked improvement in hypothyroidism by regression of HHE. A 28−day−old boy with TSH level of 77 mIU/mL on neonatal screening and diagnosed as congenital hypothyroidism was started on L−thyroxine (L−T4) (11 μg/kg/day) therapy on the 21^th day of life. On physical examination, the liver was palpable 5 cm below the right costal margin, and the thyroid gland was nonpalpable. Thyroid ultrasonography was normal. Although L−T4 dose was increased to 15 μg/kg/day, TSH was not suppressed and free T3 level remained low. HHE in both lobes of the liver was detected by abdominal ultrasonography and magnetic resonance imaging. Treatment was started with prednisolone 2 mg/kg/day and alpha−interferon 3 million U/m²/3 times per week. Thyroid dysfunction was thought to be due to type 3 iodothyronine deiodinase activity expressed by HHE. L−T4 therapy was changed to Bitiron^® tablet, which includes both T4 and T3, and euthyroidism was attained within 1 month. Thyroid hormone requirement was reduced and treatment was discontinued after regression of the HHE. At the most recent visit, the patient was 21 months old and off treatment. His growth and neurological development were normal for age and he was euthyroid. HHE should be considered in cases with severe hypothyroidism resistant to high−dose thyroid hormone replacement. The treatment of HHE in combination with T4 and T3 therapy results in euthyroidism.Conflict of interest:None declared.     

钩虫病致贫血1例

本文报道1例在大便常规检查中发现钩虫卵的贫血患者,旨在提高对大便常规检查诊断钩虫病作用的认识。