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男性,30岁,病历号 C-128755,1976年5月始低热,伴乏力、纳差,曾查肝功能正常。1977年6月体温升至38℃以上,伴全身疼痛,曾有效次鼻衄。7月中旬体温更升至39℃以上,故于8月2日首次来院急诊收住院。查体:左第五肋骨胸骨端隆起,有压痛。肝肋下1.5厘米,脾刚扪及入院后首先考虑为“慢性活动性肝炎”,“结核病”也应除外。实验室检查:血红蛋白14.1克%,白细胞6,900/立方毫米,分类正常,血小板36,000～60,000/立方毫米。尿常规、肝功能正常。乙型肝炎表面抗原(-)。血沉66毫米/第一小时。肥达氏反应、抗链“O”、血培养、结核菌素试验1:10,000、类风湿因子、抗核抗体、血清蛋白电泳、布氏杆菌凝集试验均无异常发现。十二指肠引流:引流液常规检查正常,A 管培养有绿脓杆菌生长。胸相、腰椎相-胆囊造影及胃肠造影、肝扫描均正常。曾拟肝穿刺,因血小板低未做。8月25日因屡次血小板检查均减少,为除外血液病而行骨髓穿刺,报告为急性淋巴细胞白血病。
Male, 30 years old, medical record number C-128755, low fever in May 1976, with fatigue, anorexia, had checked liver function was normal. June 1977 body temperature rose to above 38 ℃, with generalized pain, had an effective second epistaxis. In mid-July the temperature rose to 39 ℃ above, it was the first time in August 2 admitted to hospital emergency room. Physical examination: left fifth rib breast uplift, tenderness. Liver ribs 1.5 cm, spleen just palpable after admission, first considered as “chronic active hepatitis”, “tuberculosis” should be excluded. Laboratory tests: hemoglobin 14.1 grams, white blood cells 6,900 / cubic mm, normal classification, platelets 36,000 ~ 60,000 / cubic millimeter. Urine routine, normal liver function. Hepatitis B surface antigen (-). ESR 66 mm / first hour. Westerly reaction, anti-chain “O”, blood culture, tuberculin test 1: 10,000, rheumatoid factor, antinuclear antibody, serum protein electrophoresis, brucellosis agglutination test were no abnormal findings. Duodenal drainage: drainage fluid routine examination was normal, A tube culture with Pseudomonas aeruginosa growth. Chest, lumbar phase - Gallbladder and gastrointestinal imaging, liver scan were normal. Have to be liver puncture, due to low platelets did not do. August 25 due to repeated platelet tests were reduced, except for blood diseases and bone marrow puncture, reported as acute lymphoblastic leukemia.