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男患,28岁,不规则发热10月,颈腋部淋巴结肿大5月入院。原于1989年12月起反复咽痛鼻塞,6月后出现低至中度不规则发热,热可退,热前有畏寒、心悸。5个月前发现两侧颈部痛性淋巴结肿大,自觉发热时肿大明显,热退时稍缩小。查体:皮肤、巩膜无黄染,两侧颈部、腋部多个淋巴结肿大,大者蚕豆样大,活动,有压痛。心肺无异常,肝肋下2cm,脾肋下4.5cm,后多次触诊和B超肝、脾,有时可缩小。ALT40U,Hb11.8g/L,WBC3.5×10~9/L,中性杆核0.06,中性分叶核0.56,淋巴细胞0.34,单核0.04。血小板180×10~9/L,血沉8mm/h,LDH347U,ANA(-),RF(-),肥达氏反应(-),2次血培养(-),抗CMV—IgM(-)。IgG8.2g/L,IgA1.0g/L,IgM0.68g/L,C_3650mg/L,OT试验(++)。骨髓象正常,胸片在上肺增殖型肺结核。两侧颈淋巴结
Male suffering, 28 years old, irregular fever in October, neck axillary lymph node enlargement in May hospitalization. The original in December 1989 from repeated sore throat stuffy nose, after June there was low to moderate irregular fever, heat can be retreated, fever, chills, palpitations. 5 months ago, neck pain lymphadenopathy was found on both sides of the neck, when the conscious fever swollen obvious, slightly smaller thermal regression. Physical examination: skin, sclera no yellow dye, both sides of the neck, multiple lymph nodes axillary, large bean-like, activity, tenderness. No abnormal heart and lung, liver ribs 2cm, spleen rib 4.5cm, after multiple palpation and B-liver, spleen, and sometimes can be reduced. ALT40U, Hb11.8g / L, WBC3.5 × 10 ~ 9 / L, neutral rod core 0.06, neutral leaf core 0.56, lymphocyte 0.34, mononuclear 0.04. Platelet 180 × 10 ~ 9 / L, erythrocyte sedimentation rate 8mm / h, LDH347U, ANA (-), RF (-), Widal reaction (-), 2 times blood culture (-) and anti-CMV-IgM (-). IgG8.2g / L, IgA1.0g / L, IgM0.68g / L, C_3650mg / L, OT test (++). Bone marrow as normal, chest in the pulmonary proliferative pulmonary tuberculosis. Neck lymph nodes on both sides