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患者男,22岁,农民。因发热、咳嗽、咳痰伴少量咯血16个月入院。初为黄痰,无乏力、盗汗及呼吸困难,经静滴青霉素半个月症状减轻,多次胸透正常。后仍咳嗽及咳少量白粘痰,未再行系统治疗。10个月前以上症状加重,遂拍胸片示两肺弥漫性病变,于当地住院按肺含铁血黄素沉着症治疗,予以强的松45mg/d,50天无好转。3个月前于当地结核病院按肺结核正规抗痨药物治疗3个月,仍无效,且病情加重。查体:T39.6℃,P100次/min,R22次/min,Bp16/12kPa。慢性病容。双肺呼吸音粗,两肺腋背部可闻及少许湿罗音,心率100次/min,律齐,无杂音。血沉65mm/h。ASO、RF、ANA皆正常。动脉血气分析示轻度低氧血症Ig(PaO_29kPa)。痰癌细胞、痰抗酸杆菌均(一),痰找含铁血黄素的巨噬细胞(一)。心电图示窦性心动过速。胸片及肺CT示两肺弥漫性病变。
Male patient, 22 years old, farmer. Due to fever, cough, sputum with a small amount of hemoptysis admitted to hospital for 16 months. The beginning of the yellow sputum, no fatigue, night sweats and breathing difficulties, by intravenous penicillin half a month to reduce the symptoms, multiple thorax and normal. After still cough and cough a small amount of white phlegm, no further systematic treatment. 10 months ago, the above symptoms worsened, then shot chest radiograph showed diffuse lung lesions in the local hospital treatment of pulmonary hemosiderosis, to prednisone 45mg / d, 50 days without improvement. 3 months ago in the local tuberculosis tuberculosis by regular anti-tuberculosis drug treatment for 3 months, still invalid, and the condition worsened. Physical examination: T39.6 ℃, P100 times / min, R22 times / min, Bp16 / 12kPa. Chronic disease. Breath sounds coarse lungs, lungs axillary back can smell a little wet rales, heart rate 100 beats / min, law Qi, no noise. ESR 65mm / h. ASO, RF, ANA are normal. Arterial blood gas analysis showed mild hypoxemia Ig (PaO_29kPa). Sputum cancer cells, sputum acid-fast bacilli are (a), sputum to find hemosiderin macrophages (a). Electrocardiogram shows sinus tachycardia. Chest radiography and lung CT showed diffuse lung lesions.