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男患,33岁。20天前无明显诱因高热不退,体温40℃。以发热待查入内科。在内科住院期间检查:体温波动在38.5℃～40.5℃,Bp14/9kPa。贫血貌,巩膜无黄染。全身体表淋巴结不大,心肺正常。腹无压痛,肝肋下5cm,脾可触及。无腹水征。血化验检查:Hb96g/L,RBC2·85×10~(12)/L,WBC4·4×10~9/L,血小板90×10~9/L。肝功化验在正常范围。肥达氏反应正常。血培养阴性。骨髓像正常范围。尿化验均在正常范围。胸部X线片未见异常。胃镜检查:胃炎有轻度出血表现。3次检查B超,均提示脾肿大。腹部CT检查报告:脾大。疑诊脾结核?脾脓肿?脾占位性病变。病人入院高热不退,用大量抗生素及激素治疗均无效。入院第14天出现血便,一周内5次,每次便血
Male suffering, 33 years old. 20 days ago no obvious incentive to high fever, body temperature 40 ℃. With fever to be checked into the internal medicine. In the medical examination during hospitalization: body temperature fluctuations in 38.5 ℃ ~ 40.5 ℃, Bp14 / 9kPa. Anemia appearance, sclera no yellow dye. Whole body surface lymph nodes, normal heart and lungs. Abdominal tenderness, liver ribs 5cm, spleen can touch. No signs of ascites. Blood tests: Hb96g / L, RBC2 · 85 × 10-12 / L, WBC4 · 4 × 10-9 / L, platelets 90 × 10-9 / L. Liver function tests in the normal range. Widal response was normal. Negative blood culture. Bone marrow like the normal range. Urinalysis are in the normal range. Chest X-ray showed no abnormalities. Gastroscopy: gastritis with mild bleeding. B-3 times examination, all prompted splenomegaly. Abdominal CT examination report: splenomegaly. Suspected spleen and tuberculosis? Spleen abscess? Splenic lesions. Patients admitted to high fever, with a large number of antibiotics and hormone therapy are ineffective. Blood stool appeared on the 14th day of admission, 5 times a week, each blood in the stool