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例1 男,4岁.1998年10月开始反复发热,肝、脾、淋巴结肿大,当地医院考虑淋巴瘤,11月转我院 入院检查:一般情况好,心肺无异常.颈部浅表淋巴结肿大,肝肋下3cm,质中,无触压痛.脾肋下10cm,质中,未触及结节,无压痛Hb95g/L,WBC5.8 ×10~9/L,PLT 110cm×10~9/L,WBC分类:中性分叶0.41,淋巴0.45,嗜酸0.03,单核0 08,异淋0.03.骨髓片,可见单核型组织细胞及吞噬红细胞的组织细胞,但分类比值不高,仅1%,为反应性增生型骨髓象.腹腔肠系膜淋巴结活检示反应性增生.嗜异性凝集反应1:56阳性.诊断:传染性单核细胞增多综合症.按VD方案及对症治疗后好转,肝脾缩小,各项检查恢复正常,于1999年1月13日出院3月1日因发热再次入我院治疗,入院检查:肝右肋下Zcm可及,脾大平脐,Hb 92g/L,WBC 2.0×10~9/L,PLT 38×10~9/L,WBC分类:分叶0.38,淋巴0.45,单核0.09,异淋0.08,4月8日骨髓片:组织细胞总量增多,但分类比值不高,偶见异常组织细胞,可见单核淋巴样组织细胞及1.5%吞噬有核红细胞的噬血细胞,未见多核巨细胞,嗜异性凝集反应1:112阳性,传单嗜异性抗体强阳性,诊断:病毒相关性噬血细胞综
Case 1 male, 4 years old .1998 October began repeated fever, liver, spleen, lymph nodes, local hospitals consider lymphomas, admitted to our hospital in November to check: the general situation is good, no abnormal heart and lung .Naginal superficial lymph nodes Swelling, enlargement, liver ribs 3cm, quality, no tenderness. Spleen rib 10cm, quality, no touch nodules, no tenderness Hb95g / L, WBC5.8 × 10 ~ 9 / L, PLT 110cm × 10 ~ 9 / L, WBC classification: neutral leaf 0.41, lymphatic 0.45, eosinophilic 0.03, mononuclear 0 08, heterophilic 0.03 bone marrow slices, showing mononuclear cells and phagocytic cells of red blood cells, but the classification of the ratio is not high, Only 1% for the reactive hyperplastic bone marrow.Patient mesenteric lymph node biopsy showed reactive hyperplasia.Home heterophilic agglutination reaction 1:56 positive.Conclusion: Infectious mononucleosis syndrome.According to the VD program and symptomatic improvement after treatment, Liver and spleen reduced, the inspection returned to normal on January 13, 1999 was discharged from the hospital on March 1 due to fever re-admitted to our hospital for admission examination: liver right rib ribs can be Zcm, splenomegaly, Hb 92g / L, WBC 2.0 × 10 ~ 9 / L, PLT 38 × 10 ~ 9 / L, WBC classification: leaf 0.38, lymph 0.45, mononuclear 0.09, heteroplasia 0. 08, April 8 bone marrow slices: the total increase in tissue cells, Classification is not high, occasionally abnormal organization Cells, seen mononuclear lymphoid tissue and 1.5% phagocytic hemophagocytic nucleated red blood cells, no multinucleated giant cells, heterophile agglutination 1: 112 positive, leaflets heterophile antibodies strongly positive, diagnosis: virus associated hemophagocytic mechanized