<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">病例学习:非同一般的化脓性扁桃体?致命在哪里?</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2021-05-11</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:离床医学</em></h2></div><section class="" style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; text-align: justify;"><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; line-height: 1.75em; text-align: right; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 12px; color: rgb(136, 136, 136);">仅供医学专业人士参考</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; line-height: 1.75em; text-align: center; box-sizing: border-box !important; outline: none 0px !important;"><strong style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 18px; color: rgb(215, 0, 15);">病例报告</span></strong></p></section><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">患者,男性,28岁,既往无明显的病史。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>因“发热、喉咙痛和吞咽困难”于2020年11月28日入院。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>患者在7天前出现上述症状,入院前给予青霉素G肌注,左氧氟沙星500mg/d P.O,无改善。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>体格检查:</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">T39.4℃,P105次/分,BP110/60 mmHg,R18 次/分。室内空气血氧饱和度为97 %。双侧扁桃体增大,有白色渗出物覆盖。可触及双侧颈前淋巴结,压痛。腹部无压痛,脾肿大,无压痛。其他无异常。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/><strong style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text;">实验室检查:</strong><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">全血细胞计数:白细胞15600个/uL,其中多形核占38%,淋巴细胞占57%。外周血涂片:37%的非典型淋巴细胞增多,没有任何母细胞。肝功能:正常。血沉:90 mm/h。CRP:127 mg/L 。&nbsp;COVID-19的PCR:阴性。血培养:阴性。<br/><br/><strong style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text;">初步诊断及确诊:</strong><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">以传染性单核细胞增多症(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">IM</span>)收入院。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>确诊为急性EBV感染:Acute EBV infection was confirmed by the positive IgM viral capsid Ag(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">VCA Ag</span>).腹部超声:脾大。<br/>好转出院:<br/><br/>由于患者存在严重吞咽困难和上气道阻塞的高风险,给予地塞米松静脉注射8 mg,bid。3天后病情部分好转,出院后泼尼松龙30 mg/d,PO。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E0A4E2A5162DEA97C.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/></p><p><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><strong style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">病情再次加重:</span></strong></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">出院两天后,患者再次出现高热,咽喉痛加重,吞咽困难。咽部检查可见红斑,双侧扁桃体肿胀伴白色渗出物。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">ESR:85 mm/h。心电图:正常。经胸超声心动图:正常。头部和颈部静脉造影CT扫描:双边扁桃体周脓肿。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: center; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E0D96F06811DB6AE9.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 14px; color: rgb(136, 136, 136);">图1:CT示右侧扁桃体周围脓肿(23 X 45 mm)。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: center; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E109716390557C553.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 14px; color: rgb(136, 136, 136);">图2:CT示左侧扁桃体周围脓肿(14X17mm)。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: center; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">为了排除淋巴瘤,胸部和腹部静脉造影CT扫描:脾大,楔形,脾脏周围区低密度阴影,提示脾梗死。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: center; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E13B71AAB4C8803A4.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 14px; color: rgb(136, 136, 136);">图3:CT示脾大,楔形,脾脏周围区低密度阴影,提示脾梗死。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><strong style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">再次入院诊治经过:</span></strong></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">由于患者入院前和首次住院已使用多种抗生素,考虑到耐药微生物,如坏死梭菌等,给予哌拉西林-他唑巴坦静滴。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>同时,进行了双侧扁桃体切除术,随后无并发症。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>扁桃体组织病理学检查:反应性滤泡增生及脓肿形成。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">尽管脓肿培养结果阴性,但持续静脉抗生素治疗7天。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">由于无脾梗死症状,因此采取保守治疗。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">患者病情良好﹐经口服阿莫西林-克拉维酸出院,建议术后2周行腹部CT随访脾梗死。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">在随后的腹部CT中,脾梗死完全消失。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E179B17A36473D98A.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/><br/><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: center; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><strong style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 18px; color: rgb(215, 0, 15);">病例回顾</span></strong><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; caret-color: red;"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; caret-color: red;">Epstein–Barr virus(</span><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px;">EBV</span><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; caret-color: red;">)感染引起的传染性单核细胞增多症(</span><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px;">IM</span><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; caret-color: red;">)通常具有自限性。表现为发热、咽炎、疲劳和颈部淋巴结肿大。在青少年和年轻人中很常见。虽然大多数患者康复后没有任何后遗症,但很少有并发症的报道。</span><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>我们描述了一个28 岁的男性,发烧,喉咙痛,吞咽困难,IgM病毒衣壳 Ag(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">viral capsid Ag,VCA Ag</span>)阳性的EBV感染。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">入院并接受地塞米松治疗。出院后2天,患者出现急性EBV感染的罕见并发症:双侧扁桃体周围脓肿(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">peritonsillar abscess,PTA</span>)和脾梗死。虽然早期报告指出,PTA可能发生在地塞米松后,最近,没有明显的证据支持它。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>然而,在我们的病人中,较高的血沉可能意味着重叠细菌感染,使用地塞米松可加重这种情况。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">EBV感染引起的脾梗死有多种机制,如短暂的高凝状态和脾肿大引起的血供不足。由于患者在疾病期间仍无症状,因此应注意IM相关的脾并发症,包括脾梗死。病人接受了双侧扁桃体切除和保守治疗脾梗死。这两种罕见的急性EBV感染并发症尚未同时报道。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E1A1AB5331B3A5F4C.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: center; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><strong style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 18px; color: rgb(215, 0, 15);">深入学习</span></strong><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">传染性单核细胞增多症(IM)的体征和症状通常与急性EB病毒(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">EBV</span>)感染有关。IM可并发多种并发症,如上呼吸道阻塞、肝脾肿大和溶血性贫血。扁桃体周围脓肿(PTA)和脾梗死是该综合征的两个罕见并发症。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>据报道,约1%的患者因诊断IM而入院。<br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: center; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E1C1D2AE911293345.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/></p><p><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">IM患者咽部炎症、扁桃体坏死,很少合并溶血性链球菌(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">Lancef ield A、C、G 组</span>)、坏死梭菌、金黄色葡萄球菌等细菌的重叠感染。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E1F584E9050D22484.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/></p><p><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">单侧PTA通常表现为吞咽疼痛、悬雍垂和软腭偏移。<br/><br/>相反,双侧PTA是一种罕见的并发症,并导致悬雍垂不对称或偏曲。双侧PTA的一个重要的鉴别诊断是扁桃体淋巴瘤,它可能表现为双侧扁桃体大而笨重。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>在我们的病例中,淋巴瘤和白血病被扁桃体组织病理学检查和外周血涂片结果排除。<br/><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E21F92809039FF045.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/></p><p><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">在第一次入院期间,患者在即将发生气道阻塞的情况下接受了地塞米松静脉治疗。先前的两项研究结果显示,IM患者给予皮质类固醇可能增加扁桃体周围脓肿形成的潜在风险。值得一提的是,我们的患者在第一次入院时就有很高的血沉(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">90mm/h</span>),这在EBV 感染的情况下是不常见的。我们推测患者当时可能有叠加细菌感染,静脉给药皮质类固醇可能加剧细菌感染。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">然而,Hanna等人发现没有任何证据支持静脉注射皮质类固醇在PTA中作用。不幸的是,我们没有在第一次入院时进行喉咙细菌培养来检验这一假说。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>在PTA的管理中,强烈建议早期手术干预,以加快恢复和防止颈深间隙感染。因此,我们的患者接受了双侧扁桃体切除术。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E246745327CE4ABFA.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">几种感染性疾病可导致脾梗死,如巴贝斯虫病(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">babesiosis</span>)和疟疾。脾梗死是IM的罕见并发症。Yan等在 1961年至 2017年的文献中发现,因EBV合并IM的脾梗死共23例。IM患者脾梗死的确切机制尚不清楚。似乎小于40岁的患者更容易有潜在的血液病,而超过40岁的患者更容易因血栓栓塞性疾病而发生脾梗死。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">脾细胞肥大(尤其是慢性溶血性疾病)引起的血供不足、一过性高凝状态、循环免疫复合物(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">circulating immune complexes,CICs</span>)水平升高(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">促进白细胞聚集和粘附</span>)被认为是脾梗死的可能机制。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">与巴贝斯虫病不同的是,在IM中,通过生物体直接入侵红细胞而裂解,并不是IM脾梗死的主要机制;然而,CICs水平的升高可能在两种疾病中都有作用。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">与IM相似,疟疾患者的高凝状态可能导致脾梗死。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>此外,被疟疾感染的红细胞损伤内皮细胞和疟疾性贫血也是被提出的其他机制。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">意识到脾梗死的诊断可能性是至关重要的,因为它可以导致脾破裂,并导致严重的后果和死亡。脾梗死可能有广泛的临床表现,类似于我们的患者;多达30%的脾梗死可能是无症状的。然而,最常见的临床症状是左侧上腹压痛,发热、呕吐、胸膜炎性胸痛、背部或肩部疼痛是其他可能的体征和症状。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">先前的一项研究,在南部地区卡罗来纳的两家医院,根据临床表现和腹部CT扫描发现,确定了163名成人脾梗死。<br/><br/>这些患者表现为典型的腹部左上象限疼痛;47%有其他部位腹痛,33%完全没有腹痛。值得注意的是,40%的患者有不止一个易感因素,包括心源性栓塞(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">25%</span>)、癌症(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">20%</span>)、脓毒症(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">17%</span>)、炎症或感染性腹部疾病(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">16%</span>)和其他疾病。<br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">虽然腹部超声(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">US</span>)被认为是检测脾脏疾病(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">破裂、梗死、肿大等</span>)的诊断工具,但腹部CT扫描结果显示,只有18%的患者使用超声诊断。<br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">脾梗死的治疗策略主要基于基础疾病和范围,从支持治疗到脾切除术。危及生命的脾梗死并发症是假性囊肿形成、脓肿、出血、脾破裂和动脉瘤形成。</span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/>由于我们的患者无症状,且无巴贝斯虫病中发生脾切除术的任何危险因素(<span style="max-inline-size: 100%; margin: 0px; padding: 0px; cursor: text; font-family: 微软雅黑, &quot;Microsoft YaHei&quot;, Arial, sans-serif; caret-color: rgb(255, 0, 0); box-sizing: border-box !important; outline: none 0px !important;">血红蛋白≥10 mg/dl,血小板计数≥50×10⁹/L,存在血流动力学不稳定,脾脏破裂</span>),根据Dumic等人的建议,选择了保守的管理策略。考虑到脾脏破裂的可能性,建议患者在3-6个月内避免剧烈运动。<br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);"><br/></span></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><img src="https://studioyszimg.yxj.org.cn/0A00007C01795A4E275CF1266E80DFEC.jpg" alt="图片" style="margin: 0px; padding: 0px; max-inline-size: 100%; box-sizing: border-box ; outline: none 0px ;"/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><strong style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">临床警示</span></strong></p><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p><section class="_135editor" style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; border: 0px none; z-index: 0; position: relative !important;"><ul class="custom_macula list-paddingleft-1"><li class="list-macula list-macula-paddingleft"><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">我们描述了一个IM患者同时患有两个罕见的并发症,双侧PTA和脾梗死。</span></p></li><li class="list-macula list-macula-paddingleft"><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">我们的管理策略是基于患者的临床症状和潜在的危及生命的并发症:双侧化脓的扁桃体的扁桃体切除术和脾梗死的保守入路。</span></p></li><li class="list-macula list-macula-paddingleft"><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; text-align: justify; line-height: 1.75em; box-sizing: border-box !important; outline: none 0px !important;"><span style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; cursor: text; font-size: 16px; color: rgb(0, 0, 0);">由于我们的患者在疾病期间无症状,应牢记IM相关的脾脏并发症,包括脾梗死及其致命的后果。</span></p></li></ul></section><section class="_135editor" style="max-inline-size: 100%; margin: 0px; padding: 0px; box-sizing: border-box !important; outline: none 0px !important; border: 0px none; z-index: 0; position: relative !important;"><p style="max-inline-size: 100%; padding: 0px; white-space: normal; min-height: 1em; cursor: text; box-sizing: border-box !important; outline: none 0px !important;"><br/></p></section><div class="footer"><div class="item"><p class="ysz-ueditor-references-label" >参考文献 <span>共2篇<i></i></span></p><p class="ysz-ueditor-references-content textLine2" lang="en">[1].Infectious Mononucleosis Complicated with Bilateral Peritonsillar Abscess and Splenic Infarction.<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;https://doi.org/10.1155/2021/6623834&quot;}">https://doi.org/10.1155/2021/6623834</span>. <br/>[2].部分图片来源丁香园.作者:zhanglinjuan</p></div>

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