粘质沙雷氏菌肺炎一例太原铁路中心医院（０３００１３）毓珊，王俊英患者男，３０岁。因“面部皮疹，双下肢无力”确诊为皮肌炎，住院治疗４月。口服强的松９０ｍｇ／日，５０天后减量，每周减５ｍｇ至７５ｍｇ／日时，出现左侧胸部持续性疼痛，无咳嗽、咳痰，咽部充血，双侧扁桃体Ⅰ°肿大，有脓性分泌物，给洁霉素１．２ｇ／日治疗一周，胸痛无缓解，拍胸片示“左上肺浸润性病灶，密度不均匀”，疑诊为“浸润性肺结核稳定期”，给予利福平０．４５／日共５天，胸痛仍无缓解，并出现咳嗽，咳出大量灰黄色块状痰，带血丝，发冷发热，不规则热型。最高体温达３８．９°Ｃ，无心慌，无气短，唇无发绀，精神饮食好，大小便正常。查体：Ｔ３８．９℃，Ｂｐ１６／１０ｋＰａ，Ｐ８４次／分，Ｒ１４次／分，神清，自由体位，浅表淋巴结无肿大，巩膜无黄染，口唇无紫绀，咽充血，双侧扁桃体Ⅱ°肿大，无分泌物，无颈静脉怒张，胸廓对称，双侧呼吸运动均等，双肺叩诊清音，左上肺呼吸音略弱，未闻及干、湿性罗音，心率８８次／分、律齐，心脏各瓣膜区未闻及杂音，余无阳性体征。化验：血ＷＢＣ１７．７×１０９／，Ｎ０．７８，Ｓ０．０１，Ｌ０．２１，尿、便常规正常，电解质、血糖，肝功能正常，痰霉菌阴性 Case of Serratia marcescens Taiyuan Railway Central Hospital (030013) Yushan, Wang Junying Patient Male, 30 years old. Because of “facial rash, both lower extremities weakness” confirmed as dermatomyositis, hospitalized in April. Oral prednisone 90mg / day, 50 days after the reduction, weekly reduction of 5mg to 75mg / day, left chest sustained pain, no cough, sputum, pharyngeal congestion, bilateral tonsil enlargement, there Purulent secretions to the lincomycin 1.2g / day treatment for a week, no relief of chest pain, chest X-ray film showed “infiltration of the upper left lung lesions, uneven density,” suspected of “invasive tuberculosis stable period” to give Lee FOB 0.45 / day a total of 5 days, chest pain still no relief, and cough, cough, a large number of gray-yellow massive sputum, bloodshot, chills fever, irregular heat type. The highest temperature of 38.9 ° C, no palpitation, shortness of breath, no cyanosis of the lips, mental diet, normal urine. Examination: T38.9 ℃, Bp16 / 10kPa, P84 times / min, R14 beats / min, Shen clear, free position, superficial lymph nodes without swelling, scleral no yellow dye, lips without cyanosis, pharyngeal congestion, bilateral tonsils Ⅱ ° swollen, no secretions, no jugular vein engorgement, symmetrical thorax, bilateral respiratory movement were equal, the lungs percussion voiceless, left lung breath sounds slightly weaker, no smell and dry, wet rales, heart rate 88 beats / min , Law Qi, heart valve area did not smell and noise, I no positive signs. Laboratory: blood WBC17.7 × 109 /, N0.78, S0.01, L0.21, urine, they are normal, electrolytes, blood glucose, normal liver function, negative sputum mold