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病历摘要男患,20岁。住院号75739。因左下肢疼痛30余天,发热20天,于1990年7月6日入院。患者于30天前无明显诱因出现左下肢膝关节以上肿胀疼痛,局部有热感,但不红。伴有同侧下肢皮肤结节2～3个。无痛痒。四肢关节不痛。10余天后急起发热39～40℃,呈不规则热或弛张热。间断服用氯霉素、地塞米松治疗无效。入院前3天诊为“风湿热”,予先锋霉素0.5g,3次/日静注,强的松5mg,3次/日口服。既往健康。查体:体温39.8℃。热病容,皮肤粘膜无出血点和瘀斑,颈左侧可触及质韧、小枣样的淋巴结。左下肢胫骨可见2～3个直径约2～3cm的皮肤结节,轻压疼。膝关节以上明显肿胀,有触疼,表面不红。无波动感。心
Medical history male suffering, 20 years old. Hospital number 75739. Left leg pain for more than 30 days, fever 20 days, in July 6, 1990 admission. Patients with no obvious incentive 30 days before the left lower extremity knee swelling pain, local thermal, but not red. With ipsilateral lower extremity skin nodules 2 to 3. No itching. Joints and limbs do not hurt. After more than 10 days fever 39 ~ 40 ℃, irregular heat or relaxation heat. Intermittent chloramphenicol, dexamethasone treatment ineffective. 3 days before admission diagnosed as “rheumatic fever” to cephalosporin 0.5g, 3 times / day intravenous injection, prednisone 5mg, 3 times / day orally. Past health. Physical examination: body temperature 39.8 ℃. Fever, mucocutaneous bleeding spots and ecchymosis, left neck touches the quality of tough, jujube-like lymph nodes. Left lower limb visible tibia 2 ~ 3 diameter of about 2 ~ 3cm of skin nodules, light pressure pain. Significantly above the knee swelling, touch pain, the surface is not red. No fluctuation. heart