以鼻出血为首发症状的恙虫病1例

Nasal bleeding as the first symptom of tsutsugamushi disease:a case report

患者，男，76岁，因右鼻出血2h于2012年07月05日急诊入院。体检：体温36．1℃，脉搏106次／min，呼吸次20／min，血压131／81mmHg，神清，精神疲倦，表情自如，查体配合。无明显贫血貌。双侧little’s区未见出血点。双鼻腔见新鲜血迹，鼻中隔向右偏曲，偏曲处黏膜血管纹分布明显，充血明显。右侧中鼻道见新鲜血迹，未见新生物。鼻咽部未见新生物，无活动性出血点。

Summary A case of 76 years-old male patient with nasal bleeding as the first symptom in our hospital, who was finally diagnosed as tsutsugamushi disease. This old man was bited by insect in farmland 2 clays before the symptom occurred. PE： Left thigh and right buttock have eschar,with splenomegaly. Routine blood test： WBC （ ↓ ）3.9 × 109/L,RBC（ ↓）3. 86 × 109/L, PLT（ ↓ ）41 ×109/L, HGB（ ↓ ）117 g/L;Chest CT： lung interstitial pneumonia, a small amount of bilateral pleural effusion. Oxk-ag 1：320. The patient was discharged after treat- ment with chloramphenicol for 8 days.