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患者 男,40岁,供销员。因咯血2天约400ml,于1995年11月2日急诊入院。入院查体T36.8℃,P85次/分,BP15/9kPa(112/67.5mmHg),浅表淋巴结不肿大,双肺呼吸音清晰,未闻及干性和湿性啰音,心律齐,肝脾不肿大。实验室检查:Hb130g/L,WBC7×10~9/L,N0.78,L0.22,血沉10mm/1h,血结核抗体(+),1:2000PPD皮试弱阳性,多次痰找脱落细胞及抗酸杆菌均阴性。胸部X线片未见异常,CT示右上肺尖后段片状、斑片状阴影,诊断为肺结核,予以抗结核治疗。1周后患者突然出现连续5天周期性寒战、高热,最高达40.5℃,呈间日热型,出汗热退。多次查痰及外周血未找到疟原虫,骨髓涂片找到间日疟原虫,确诊肺炎型疟疾肺,停止抗结核治疗,予以氯喹、伯喹治疗3天体温正常,咯血消失,3周后复查胸部CT示炎症吸收,出院后随访半年无复发。
Male patient, 40 years old, sales staff. Due to 2 days of hemoptysis about 400ml, in November 2, 1995 emergency admission. Admission examination T36.8 ℃, P85 beats / min, BP15 / 9kPa (112 / 67.5mmHg), superficial lymph nodes did not enlarge, lung breath sounds clear, no smell and wet and dry rales, Qi Qi, liver Spleen does not enlarge. Laboratory tests: Hb130g / L, WBC7 × 10 ~ 9 / L, N0.78, L0.22, erythrocyte sedimentation rate 10mm / 1h, blood tuberculosis antibody (+), 1: And acid-fast bacilli were negative. Chest X-ray showed no abnormalities, CT showed the posterior segment of the right upper lung lamellar, patchy shadows, diagnosis of tuberculosis, anti-TB treatment. One week later, the patient suddenly appeared for 5 consecutive days of periodic chills, high fever, up to 40.5 ℃, was day heat type, sweating fever retreat. Multiple sputum and peripheral blood did not find the malaria parasite, bone marrow smear found Plasmodium vivax, diagnosed pneumonia type of malaria lung, stop anti-TB treatment, to chloroquine, primaquine 3 days normal body temperature, hemoptysis disappeared, 3 weeks after the review Chest CT showed inflammation absorption, follow-up after discharge for six months without recurrence.