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患者女性,74岁。因咳嗽、咳痰20余天伴畏寒、发热1周于1995年3月21日入院。入院前体温37.8℃(上午)～39℃(下午),痰呈白色泡沫状,不易咳出。血WBC4.3×10~9/L,NO.84,LO.13。胸透示两侧支气管病变伴感染。患者曾因右侧胸膜炎住某院治疗,出院后未服任何药物。呈老年貌,唇不绀,呼吸平稳,心率100次/分,律齐,A_2>P_2,未闻及病理性杂音。两肺呼吸音粗。腹软,肝未及,脾肋下刚及。左膝关节活动障碍(骨折愈合),未见杵状指,神经系统检查正常。血、痰培养(送市一医院检查)均阴性。ESR27mm/h,胸片示两肺纹理增粗,两肺下野散在斑点状阴影,心胸比例大于1:2,主动脉硬化。初诊:支气管感染,动脉硬化性心脏病。先后予多种抗生素治疗,体温仍波动在37.8℃～39℃,并有盗汗、纳呆、而咳嗽、咳痰减轻,无明显气急。查AFP、铁蛋白、CEA、SA均正常。痰厚涂片找抗酸杆菌2次均阴性,PPD试验++,结核特异性抗体强阳性(OD值为
Patient female, 74 years old. Due to cough, sputum more than 20 days with chills, fever 1 week in March 21, 1995 admitted. Pre-admission temperature 37.8 ℃ (morning) ~ 39 ℃ (afternoon), sputum was white foam, easy to cough. Blood WBC4.3 × 10 ~ 9 / L, NO.84, LO.13. Chest radiographs showed bronchial lesions on both sides with infection. Patient had lived in a hospital for pleurisy on the right side and was not given any medication after discharge. Aged appearance, lip cyanosis, stable breathing, heart rate 100 beats / min, law Qi, A_2> P_2, no smell and pathological murmur. Breath sounds coarse two lungs. Abdominal soft, liver and spleen and ribs just. Left knee movement disorders (fracture healing), no clubbing, nervous system examination was normal. Blood, sputum culture (sent to a hospital for examination) were negative. ESR27mm / h, chest X-ray showed thickening of the two lungs, two lungs under the scattered spots in the shade, the ratio of more than 1: 2 cardiothoracic aortic sclerosis. New diagnosis: bronchial infection, arteriosclerotic heart disease. Has given a variety of antibiotics, the body temperature is still fluctuating between 37.8 ℃ ~ 39 ℃, and night sweats, poor appetite, and cough, expectoration reduce, no obvious shortness of breath. Check AFP, ferritin, CEA, SA are normal. Sputum thick smear to find acid-fast bacilli 2 times were negative, PPD test ++, TB-specific antibodies strong positive (OD value