第六例——原发性干燥综合征、肺部阴影（Sixth cases of primary Sjogrens syndrome and pulmonary shadow）.doc

第六例——原发性干燥综合征、肺部阴影（Sixth cases of primary Sjogrens syndrome and pulmonary shadow） Sixth cases of primary Sjogrens syndrome and pulmonary shadow 2011-09-13 Hu Mingming Zhang Wen 1 Summary of patient history Patient: female, 57 years old. Chief complaint: joint pain for 30 years, mouth and eye dry for 15 years, shortness of breath for 1 years, aggravating 10 d. 30 years ago the knees, hip, shoulder pain, and leg purpura; 15 years ago, dry mouth, difficulty swallowing, teeth exfoliation, dry eyes no tears; 13 years ago, I found 54% hospital gamma globulin, eye BUT, Schirmer s test positive, saliva flow rate, parotid were abnormal and the diagnosis of primary Sjogren syndrome. The symptoms of chloroquine and Tripterygium wilfordii were relieved. In 1989, the swelling and swelling of the joints were increased. Prednisone was added. In 1992, fever, cough and yellow sputum were repeated, and chest X-ray showed interstitial fibrosis. After the anti-inflammatory treatment, cyclophosphamide (CTX) Gym Lan was added successively, but the curative effect was not good. In May 1993, anti SSA antibodies, 1 to 64 (+), ANA 1, 160, ACL antibody (), lung V/Q imaging showed multiple abnormal reflex reduction zones, ammonium chloride load test (+), prednisone and melphalan treatment, symptomatic relief. August 1997, fever, chest pain, shortness of breath, chest X-ray showed right lower lung fiber cord, ANA 1: 640, anti ds-DNA 49.6% (Farr), treated with methylprednisolone and prednisone followed by CTX treatment for thoracic puncture two, exudative pleural effusion, once see suspicious tumor cells TB-PCR, (-), bacterial culture (-). In June 1999, he was admitted to hospital for 2 weeks with chills, high fever (Tmax 40 degrees), cough and purulent sputum. Chest X-ray shows the anterior segment of the upper lobe of the right lung, sputum culture (+). With a history of pulmonary tuberculosis, personal history, family history of special. Physical examination: body temperature 37.7 degrees, P