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病例3-2019:一名患发热、头痛和进行性脑病的70岁女性
Case 3-2019 — A 70-Year-Old Woman with Fever, Headache, and Progressive Encephalopathy


Kimon C. Zachary ... 其他 • 2019.01.24

陈述


John I. Hogan医师(内科):一名既往有偏头痛病史的70岁女性因发热、头痛和进行性脑病于秋季入住本院。

本次入院前12日,患者发热(体温高达39.7℃),伴寒战、疲乏、虚弱和头痛,此前患者健康状况如常。患者还有恶心和间歇性呕吐。患者服用了对乙酰氨基酚和舒马曲坦,但症状未见改善。起病第6日,患者的初级保健医师对其进行了检查。流感快速检测结果呈阴性,尿液检查报告结果正常;将血样送到实验室进行伯氏疏螺旋体(Borrelia burgdorferi)抗体检测。

次日,患者至另外一家医院的急诊科就诊,接受进一步检查。检查时,患者发热,急病面容。血小板计数、凝血酶原时间国际标准化比值、阴离子间隙以及血电解质和乳酸水平正常,肾功能检查和尿液检查结果也正常;其他实验室检查结果见表1。将血液和尿液样本送去培养。胸片检查结果正常。进行了腰椎穿刺;脑脊液(CSF)分析结果见表1。静脉给予万古霉素和哌拉西林-他唑巴坦,建议住院。患者拒绝住院,离院回家,为患者开了口服多西环素处方。





作者信息

Kimon C. Zachary, M.D., Regina C. LaRocque, M.D., M.P.H., R. Gilberto Gonzalez, M.D., Ph.D., and John A. Branda, M.D.
From the Departments of Medicine (K.C.Z., R.C.L.), Radiology (R.G.G.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (K.C.Z., R.C.L.), Radiology (R.G.G.), and Pathology (J.A.B.), Harvard Medical School — both in Boston.

 

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