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伤寒为常见传染病,临床表现典型者,诊断并不困难,我们遇一例伤寒误诊为肝炎,现报告如下。陈某,男,38岁。发热、乏力、恶心、右上腹隐痛4天于1987年12月3日初诊。查体:T38.6℃,精神状况差,皮肤、巩膜微黄,心率62次/分,律齐,两肺(一),腹平软,肝肋下1cm,质软,有触痛,脾肋下1cm,质软,腹水(-)。化验检查:白细胞4.2×10~9/L,N0.72,L0.26,M0.02.血清总胆红质60.3μmol/L,1分钟胆红质50.1μmol/L,ALT200u,ZnTT13u,TTT8u,诊断为病毒性肝炎黄疸型。给予能量合剂及齐墩果酸片治疗。翌日,T40℃,脉搏72次/分,ECG正常,肝胆B超提示“肝肿大、胆囊炎”。故加用氨苄青霉素。12月8日肝炎免疫指标报告:HBsAg、抗HBs、抗HBc、HBeAg、抗HBe、抗HAVIgM均阴性。肥达氏反应O1:320、H1:320、A1:40、B1:40。故确诊为伤寒,又加用氟哌酸治疗,2周后痊愈。复查肝功能及血清胆红质均恢复正常,肥达氏反应O1:640,H1:640,A1:0,B1:0。讨论伤寒患者常有肝肿大,部分病人伴有肝功能损害,近4年我院收治250例伤寒病人,肝肿大者占55%,伴有ALT异常13例,其中轻中度异常11例,1例误诊为肝炎。
Typhoid fever is a common infectious disease, the typical clinical manifestations, the diagnosis is not difficult, we encountered a case of typhoid fever misdiagnosed as hepatitis, are as follows. Chen, male, 38 years old. Fever, fatigue, nausea, pain in the right upper quadrant 4 days in December 3, 1987 newly diagnosed. Physical examination: T38.6 ℃, poor mental condition, skin, scleral yellow, heart rate 62 beats / min, law Qi, both lungs (a), abdomen soft, liver ribs 1cm, soft, tenderness, spleen Under the ribs 1cm, soft, ascites (-). Laboratory tests: white blood cells 4.2 × 10 ~ 9 / L, N0.72, L0.26, M0.02 serum total bilirubin 60.3μmol / L, 1 minute of bilirubin 50.1μmol / L, ALT200u, ZnTT13u, TTT8u, Diagnosis of viral hepatitis jaundice. Give energy mixture and oleanolic acid tablets treatment. The next day, T40 ℃, pulse 72 beats / min, normal ECG, liver and gallbladder B-prompt “hepatomegaly, cholecystitis.” Therefore add ampicillin. December 8 hepatitis immune indicators report: HBsAg, anti-HBs, anti-HBc, HBeAg, anti-HBe, anti-HAVIgM were negative. Widal reaction O1: 320, H1: 320, A1: 40, B1: 40. Therefore, the diagnosis of typhoid fever, but also add norfloxacin treatment, recovered after 2 weeks. Review of liver function and serum bilirubin were returned to normal, Widal reaction O1: 640, H1: 640, A1: 0, B1: 0. Discussion Typhoid fever patients often have hepatomegaly, some patients with liver damage, nearly 4 years admitted to our hospital in 250 cases of typhoid fever, hepatomegaly accounted for 55%, accompanied by abnormal ALT in 13 cases, including mild to moderate abnormalities in 11 cases , 1 case misdiagnosed as hepatitis.