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近年恶性疟原虫对氯喹的耐药性有所增加,现将一例耐药恶性疟疾被误诊为恶性网织细胞增多症报告如下:患者李某某,女,23岁,海南岛人.因畏寒、发热一月入院.一月前开始畏寒、发烧、烧退出汗,无规律性发作,曾按感冒治疗,注射青链霉素无效.经县医院骨髓穿刺,发现恶性疟原虫,先后两次给以常规氯喹加乙胺嘧啶治疗,但高烧不退,并出现皮肤粘膜出血,进行性贫血,肝脾肿大,因而临床怀疑恶性网织细胞增多症,用大剂量皮质激素治疗亦无效,病情恶化,在武汉市某医院门诊,经骨髓穿刺,初步诊断为恶性网织细胞增多症前期.当时返回县医院,再次以大剂量激素治疗无效,转入我院传染科.患者平素身体健康,两年前患过“间日疟”,无“肝病、肾病、心脏病”史.入院体检:T38℃,P1(?)6次,R30次,Bp150/100mmHg,危重病容,重度贫血貌,半靠位,神清,全身浮肿,胸骨柄无压痛,心尖部闻Ⅱ级收缩期杂音,两肺底闻干湿性罗音,腹水征阳性.宫底脐下两横指.肝右肋缘下2cm,脾大1.5cm.诊断:1.发烧、贫血原因待查:①恶性疟
In recent years, Plasmodium falciparum chloroquine resistance has increased, now an example of malignant malaria was misdiagnosed as malignant reticulosis reported as follows: Lee Moumou, female, 23 years old, Hainan Island due to chills , Fever January hospitalization.A month ago began chills, fever, burning out of sweat, irregular seizures, according to the flu treatment, injection of streptomycin ineffective. County hospital bone marrow puncture and found that Plasmodium falciparum, twice Given conventional chloroquine plus pyrimethamine treatment, but high fever, and skin and mucous membrane bleeding, anemia, hepatosplenomegaly, and therefore suspected of malignant reticuloendotheliosis, high-dose corticosteroid therapy is also invalid, the condition Deteriorated in Wuhan City, a hospital clinic, the bone marrow puncture, the initial diagnosis of malignant reticulocytosis before the return to the county hospital, once again to high-dose hormone therapy is invalid, transferred to our hospital department of infectious diseases. Patients usually healthy, two Years before suffering from “malaria,” no “history of liver disease, kidney disease, heart disease.” Physical examination admission: T38 ℃, P1 (?) 6 times, R30 times, Bp150 / 100mmHg, critically ill patients with severe anemia, Bit, clear, body edema, no tenderness of the sternum, apical smell Grade systolic murmur, two lungs at the end of the smell of wet and dry rales, ascites sign positive Palace under the umbilical two transverse refers to the right hepatic margin 2cm, splenomegaly 1.5cm Diagnosis: 1. fever, anemia To be investigated: ① falciparum malaria