新英格兰双语病例讨论2课件.pptVIP

; A 35-year-old man with dyspnea, anemia, and renal failure;;; On examination, T 36.9°C, BP 173/89 mm Hg, P 95b/m, R36 b/m, and S02 88% ( ambient air). The skin and conjunctivae 结膜were pale, and there were hypopigmented macules 色素减退斑on the right temple and both lower cheeks and hyperpigmented macules 色素沉着斑on the bridge of the nose.There were bibasilar rales双肺底湿罗音 in the lungs, and the remainder of the examination was normal.;;;; total and direct bilirubin胆红素, liver-function tests and lactate were normal .testing for rheumatoid factor ,screening of the blood and urine for toxins were negat