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讨论一、诊断问题本例有如下特征:1.多系统损害。(1)关节:大关节为多发性、游走性关节炎,可完全恢复,不留痕迹,呈风湿性损害表现。指关节呈梭形肿胀,始终不消退,呈类风湿性损害表现。(2)心脏:心音低钝,心率增快,有心脏杂音、心包摩擦音及心电图 ST—T改变,表明心肌、心内膜、心包均受损害,是心脏炎的表现。病程中,心尖部曾出现收缩期海鸥鸣样乐性杂音,临床上有不规则发热、寒战、脾肿大,血培养阳性。(3)皮肤损害为经久不愈的溃疡,后期在日晒后面部出现分布对称的红斑,累及鼻梁,为典型的蝶形红
Discussion First, the diagnostic problems This example has the following characteristics: 1. Multi-system damage. (1) joints: large joints for multiple, migratory arthritis can be completely restored, leaving no trace of rheumatic damage performance. Knuckles were fusiform, always does not fade, showed the performance of rheumatoid damage. (2) heart: low heart sound blunt, heart rate, heart murmur, pericardial friction sound and ECG ST-T changes, indicating that myocardial, endocardial, pericardium are damaged, is the performance of carditis. During the course of the disease, the apical systolic murmur of the seagull appeared, and there was irregular fever, chills, splenomegaly, and blood culture positive in clinic. (3) Skin damage is a chronic ulcer, the latter part of the sun appeared in the face after the distribution of symmetrical erythema, involving the nose, as the typical butterfly red