恶性淋巴瘤3例误诊分析
JOURNAL OF WEIFANG MEDICAL COLLEGE(2002)
Abstract
例1,患者,男,47岁,因不规则发热1个月入院.查体无阳性体征,血常规、胸片、骨髓象正常,血培养阴性.给予联合抗生素治疗10d无效,改用抗痨药半个月仍不退热.转上级医院诊断为变应性亚败血症,口服强的松40mg,每日1次,20d后体温正常,激素逐渐减量至10mg,每日1次.4个月后病人出现腹痛、腹胀、乏力,第2次入院.查体:满月脸,全身浅表淋巴结无肿大,心肺正常,腹膨隆,腹壁柔韧感,全腹轻压痛,未扪及包块,肝脾未触及,移动性浊音阳性.血沉25mm/h,血常规正常.腹部B超示腹腔积液.腹穿腹水微黄色,李瓦特试验阳性,细胞数300个/m3,L 0.60,N 0.40,未查到抗酸杆菌及瘤细胞.拟诊结核性腹膜炎,抗痨治疗1个月无好转.仔细查体,在病人右腋窝触及一黄豆大小淋巴结,取活检病理报告为恶性淋巴瘤.
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