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患儿女,10岁,因“全身猩红样皮疹一天”就诊。患儿两天前流清涕,咽痛,全身不适,关节疼痛。发热,体温38℃左右。次日起,耳后、颈部及上胸部出现猩红样皮疹。家长给予头孢氨苄。查体:体温38℃,耳后、颈部、胸、腹部,双下肢广泛散布着针尖大小、稍隆起的点状猩红样皮疹,高出皮肤、压之腿色。腹部疹与疹之间皮肤弥漫性充血。咽部充血明显,扁桃体Ⅲ度肿大。双眼睑及双下肢浮肿,尤以踝关节明显。关节处皮温高, 肿胀、压疼、活动受限。实验室检查:血常规:白细胞2. 1×109/L,中性粒细胞0.8,淋巴细胞1.20,Hb108g/ L。尿常规:尿蛋白++,潜血±。考虑猩红热合并关节炎,肾小球肾炎。治疗给予青霉素、激素、卧床休息,治疗7天后皮疹完全消退,双眼睑、双下肢及踝关节浮肿消退,左脚掌有麦麸样蜕皮。10天后改为青霉素V钾片口服,激素逐渐减量停药。二周后复查血、尿常规均
Children with children, 10 years old, because of “whole body scarlet-like rash a day ” treatment. Two days ago, children shed tears, sore throat, general malaise, joint pain. Fever, body temperature about 38 ℃. The next day, after the ear, neck and upper chest appeared scarlet-like rash. Parents gave cephalexin. Physical examination: body temperature 38 ℃, behind the ear, neck, chest, abdomen, both lower extremities widened the tip size, a little bulge of scarlet-like rash, higher than the skin, the pressure of the leg color. Abdominal rash and rash between the skin diffuse congestion. Throat congestion, tonsil III degree enlargement. Eyelid and lower extremity edema, especially in the ankle. Joint skin temperature is high, swelling, tenderness, limited activity. Laboratory tests: blood: white blood cells 2. 1 × 109 / L, neutrophils 0.8, lymphocytes 1.20, Hb108g / L. Urine: Urinary protein ++, occult blood ±. Consider scarlet fever with arthritis, glomerulonephritis. Treatment given penicillin, hormones, bed rest, rash completely subsided after 7 days of treatment, double eyelid, lower extremities and ankle edema subsided, left foot palm bran-like molting. 10 days later changed to penicillin V potassium tablets oral, hormone tapering withdrawal. Two weeks after the review of blood, urine routine are