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患者张××,男性,30岁,桓台县人,已婚,门诊号66933。主诉:突然高烧、喉痛、全身酸痛1天,于1964年3月30日来我院急诊。现在症:患者自1960年以来时有咳嗽,吐痰,疲倦,失眠及盗汗等症状,在某医院曾诊为浸润型肺结核上/上。自患病后经常间歇服用異烟肼,每日300毫克;1964年2月因咯血,自行加大剂量,服用異烟肼每日600毫克;1964年3月30日突然高烧,喉疼,头痛,食欲不振,全身酸痛,而来急诊。过去史:近年来除简歇服用異烟肼外,再未服其它任何药物。体格检查:体温39.5℃,脉搏85次/分,血压110/70毫米汞柱。精神不振,咽部充血,并有如小米大小之溃瘍面,两侧扁桃体呈1°肥大充血,心肺及腹部无異常。化验:白细胞4050,中性28％,淋巴72％,红细胞356万,血红蛋白88％,血沉(位氏法)2毫米/小时,血小板24万,痰查结核菌三次均阴性。 X线胸片:两肺上野有密度不匀而边缘较模糊之
Patients Zhang × ×, male, 30 years old, Huantai County, married, outpatient number 66933. Chief complaint: sudden high fever, sore throat, body aches 1 day, March 30, 1964 to our hospital emergency room. Now Symptoms: The patient has been coughing, spitting, tired, insomnia and night sweats since 1960 and has been diagnosed as infiltrating pulmonary tuberculosis in / from a hospital. Since the illness often intermittent with isoniazid, 300 mg daily; February 1964 because of hemoptysis, to increase their own dose of 600 mg of isoniazid daily; March 30, 1964 sudden high fever, sore throat, headache , Loss of appetite, body aches, and emergency. Past history: In recent years, apart from simple to take isoniazid, then no other drugs. Physical examination: body temperature 39.5 ℃, pulse 85 beats / min, blood pressure 110/70 mm Hg. Lack of energy, pharynx congestion, and as the size of the ulcer ulcer surface, both sides of the tonsils showed hypertrophy 1 °, no abnormal heart and lungs and abdomen. Laboratory tests: white blood cells 4050, 28% of neutral, lymphatic 72%, 3.56 million red blood cells, hemoglobin 88%, ESR (bit method) 2 mm / hour, 240,000 platelets, sputum check TB negative three times. X-ray: both lungs have uneven density and the edge of the more ambiguous