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临床讨论本病例特点:①青壮年,男性,病程将近1年,全血细胞减少,肝脾轻度肿大;②不规则发热;③发病半年后出现双下肢截瘫。根据本病例特点在临床诊断和鉴别诊断上考虑下列疾病。一、伤寒:患者第1次入院初有发热,相对缓脉,肝大,白细胞减少,无嗜酸粒细胞,首先应考虑伤寒。但肥达氏反应阴性。血及骨髓培养伤寒杆菌阴性,氯霉素治疗无效,可以排除本病。二、传染性单核细胞增多症:本例有不规则发热,起病时有上呼吸道炎表现,虽然淋巴结和脾初期
Clinical discussion of the characteristics of this case: ① young adults, the course of the disease nearly 1 year, pancytopenia, liver and spleen mild enlargement; ② irregular fever; ③ onset of paraplegia after six months of lower extremity. According to the characteristics of this case in the clinical diagnosis and differential diagnosis of the following diseases. First, typhoid fever: patients with fever at the beginning of the first admission, the relative slow pulse, hepatomegaly, leukopenia, eosinophils, should first consider typhoid fever. But Widal reaction negative. Blood and bone marrow culture typhoid bacillus negative, chloramphenicol ineffective, you can rule out the disease. Second, infectious mononucleosis: This case has irregular fever, when the onset of upper respiratory tract inflammation, although the initial stage of lymph nodes and spleen