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患者男,22岁,大学生。因发热、咳嗽3天就诊。查体:T 39℃,发育营养良好,双肺呼吸音粗。胸片示右肺门旁模糊阴影。CT示右肺门旁结节样病灶。诊断为“结节病”。给予青霉素、地塞米松治疗两周,热退、咳嗽减轻。后继用红霉素、地塞米松治疗10天,仍轻咳、不发热而停止治疗。2月后复发,右肩胛间闻及散在湿罗音,胸片示右肺门3cm×2.5cm大小致密阴影,右中肺野可见密度不均匀片状模糊阴影,侧位片相当于下叶背段。ESR:30mm/h,OT试验(1/万):6cm×7cm,痰培养(-)。给予青霉素、氨苄青霉素治疗,患者咳嗽加重、不发热,遂改用抗痨治疗(链霉素、利福平、雷米封),20天后复查胸片示阴影范围扩大。支气管镜检查:右肺上叶、中叶及下叶背段开口处各见一结节状突起,表面不光
Male patient, 22 years old, college student. Due to fever, cough 3 days treatment. Physical examination: T 39 ℃, well-developed nutrition, lung breath sounds rough. Chest radiograph shows the right hiv blurred shadow. CT showed right hilar nodular lesions. Diagnosed as “sarcoidosis.” Give penicillin, dexamethasone for two weeks, hot retreat, reduce cough. Followed by erythromycin, dexamethasone for 10 days, still light cough, no fever and stop treatment. 2 months after the recurrence of the right intercapillary smell and scattered in the wet rales, chest X-ray showed the right hilar 3cm × 2.5cm size dense shadow, visible in the right lung field uneven density flaky shadows, flaps the equivalent of the lower back segment . ESR: 30 mm / h, OT test (1 / 10,000): 6 cm × 7 cm, sputum culture (-). Give penicillin, ampicillin treatment, the patient increased cough, no fever, then switch to anti-tuberculosis treatment (streptomycin, rifampicin, Remy seal), 20 days after the review chest X-ray showed an enlarged range. Bronchoscopy: the right upper lobe, middle and lower lobe openings each see a nodular protuberance, the surface is not only