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患儿男性,10岁,住院号918。因游走性关节肿痛1年,头部肿块6个月,不能行走1个月伴胸闷、恶心、呕吐于1984年3月4日入院。体检:发育营养差,慢性重病容。面色苍白,左眼球轻度突出。颈部、颌下,锁骨上及腋下和腹股沟处可触及黄豆大淋巴结10余个,不活动,无压痛。左颈部有一3×4×2cm肿块。质中,无波动感,无压痛。头颅骨高低不平,有12处突起,大小不等,无压痛。两肺呼吸音粗糙。心浊音界向左下扩大,心前区闻及Ⅲ级收缩期杂音。腹软,未及肿块,肝肋下2cm,质软,脾肋下未及。两膝关节及左肘关节肿胀压痛、活动受限,两下肢肌肉萎缩,全身骨骼均有压痛,皮肤未见出血点和皮疹。实验室检查:IIb24g/L;WBC7.8×10~9/L,N55％,L45％;PL25×10~9/L;偶见幼稚粒细胞。ESR185mm/h。
Children with children, 10 years old, hospital number 918. Due to migratory joint swelling and pain for 1 year, head lumps for 6 months, can not walk 1 month with chest tightness, nausea, vomiting was admitted on March 4, 1984. Physical examination: poor nutrition, chronic severe disease. Pale, slightly prominent left eyeball. Neck, submandibular, supraclavicular and armpit and groin can reach more than 10 large soybean nodes, inactivity, no tenderness. The left neck has a 3 × 4 × 2cm mass. Quality, no fluctuation, no tenderness. Skull rugged, there are 12 processes, the size range, no tenderness. Breathe sound rough between the two lungs. Diabolic heart bound to expand to the left, precordial and grade Ⅲ systolic murmur. Abdominal soft, no mass, liver ribs 2cm, soft, spleen and ribs under the time. Two knees and left elbow swollen tenderness, limited mobility, two lower extremity muscle atrophy, body bones have tenderness, the skin no bleeding and rash. Laboratory tests: IIb24g / L; WBC7.8 × 10 ~ 9 / L, N55%, L45%; PL25 × 10 ~ 9 / L; occasionally immature granulocytes. ESR185mm / h.