SLE英语巡诊周三终版.pptxVIP

Fever, Rash, Convulsion and Cough Miss Sun, an 18-year-old young woman, was admitted to PUMCH with complaint of fever and rash for 1 month 2006-1 A Rash developed after shower Distributed on the back, hip, upper limbs and thighs Red (not change under pressure) Raised, and partially fused Itchy, but not painful Fever Irregular, T not measured Cold Development of the Rash → Face, ears → Desquamation Symptoms improved spontaneously 2006-1-7 Fever recurred Mainly in the afternoon, Tmax 39.4℃ No chills, night sweats, fatigue, cough, headache or joint pain Fever + Rash ? Important information for differential diagnosis? Cause of onset, relationship between Fever and Rash, features of rash/fever, accompanied manifestations… measles, rubella, infectious mononucleosis； scarlet fever, typhus, TB； SLE, Still’s disease, systemic vasculitis, rheumatic fever Lymphoma Drugs Infectious disease Autoimmune disease: Malignant disease Hypersensitivity Virus: Bacteria: Local Hospital CBC：WBC 2.01x10^9/L, Hgb 90g/L, PLT 186x10^9/L Urine RT(-) Stool RT (-) ALT 28U/L, ALB 3.2g/dL,A/G 1.28,Cr 0.6mg/dL “WBC 2.01x10^9/L” Leukopenia! (WBC 4.0x10^9/L) Mechanisms? What examinations should we perform then (for leukopenia)? Differential count of WBC, Blood/ bone marrow smear (biopsy), BUS, CT scan, Auto-ab… + Fever and Rash? Deficient production Increased destruction/consumption Suppressed stem cells: AA, radiation, drugs Ineffective granulopoiesis: VB12, MDS Microenvironment: Malignant tumor (lymphoma, leukemia, others (BM involved)), MF Autoimmune: SLE, Felty syndrome Infection: typhoid fever, Brucellosis, TB, malaria, virus (HIV, CMV, EBV, hepatitis） Hypersplenism/splenomegaly effusions CT bilateral pleural effusion Enlarged mediastinal and axillary lymph nodes BUS: pleural effusion, pelvic effusion,ascites, pericardial effusion Splenomegaly The cause? EXudate or TRANSudate? Exudate Transudate Apearance clear cloudy Specific gravity 1.012 1.020 Protein content 2.5g/dL 2.5g/dL Fluid