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患者女,48岁。无何诱因出现腰骶部、左膝关节剧痛已7～8天,行动困难。检查:痛苦表情,贫血貌。T36.8℃。腰_4～骶_1及左髂嵴处轻压痛,局部软组织无异常,四肢诸关节无红肿及功能障碍。化验室检查:血红蛋白10g%,白细胞11,000,中性34%,淋巴64%,嗜酸性粒细胞2%。按“腰肌劳损”,“纤维组织炎”治疗无好转,贫血加重收住院。入院后摄腰椎正、侧位片未见骨质异常,复查血像白细胞5,700,,血红蛋白9g%,血沉118mm。按“风湿痛”继续给予青霉素、强的松等治疗18天,临床症状仍无缓解,全身情况急剧恶化。因前臂注射部位出现出血性瘀斑再次复查血像:红细胞223万,血红蛋白4.5g%,血小板5.6万,血沉160mm,白细胞9400,
Female patient, 48 years old. No incentive to appear lumbosacral, left knee pain has been 7 to 8 days, difficult to move. Check: painful expression, anemia appearance. T36.8 ° C. Lumbar _4 ~ sacral _1 and left iliac crest mild tenderness, no abnormalities in local soft tissue, limbs and joints without swelling and dysfunction. Laboratory tests: hemoglobin 10g%, 11,000 leukocytes, 34% neutral, lymphatic 64%, eosinophils 2%. Press “lumbar muscle strain,” “Fibrous tissue inflammation” treatment did not improve, anemia increased hospitalization. After admission, lumbar spine is positive, no lateral abnormalities were bone abnormalities, review blood white blood cells 5,700 ,, hemoglobin 9g%, erythrocyte sedimentation rate 118mm. According to “rheumatic pain” continue penicillin, prednisone and other treatment for 18 days, the clinical symptoms still did not ease, the general condition deteriorated dramatically. Hemorrhagic ecchymosis due to forearm injection site re-examination of blood: 2230000 erythrocytes, hemoglobin 4.5g%, platelets 56000, erythrocyte sedimentation rate 160mm, 9400 white blood cells,