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1 病例介绍 患者,男,52岁,行同种异体肾移植术后4年余,因出现肾功能不全而致进行性尿蛋白及全身浮肿入院。住院期间出现持续发热,左锁骨上淋巴结增大,经活检及PCR检测,临床确诊为“左锁骨上淋巴结核”。遂用异烟肼抗痨治疗。休检:慢性病容,全身浮肿,心肺未见异常,病理反射未引出。实验室检查:Hb 68g/L,WBC9.9 × 10~9/L,尿Pr(+++),SCr694μmol/L,CCr每24小时6.92L,BUN31.9mmol/L,chol7.9mmol/L,A/G3.8/2.8,TG6mmol/L,SGPT18μ/L,K4.5mmol/L。予以异烟肼(广东省制药工业公司华南制药厂生产,批号940901),0.3g,PO,qd。1周后出现幻想性精神症状,如总认为病房天花板漏水,要求换房;反应迟钝,思维混乱,言语词不达意,对答不切题。体检:右乳房肿胀,男性乳房女性化;轻压有痛感,但无硬块,表面不红,挤压时无乳汁外溢。辅检脑电图异常;生命体征及实验室检查与服药前无明显变化。停用异烟肼后7d,异常精神症状消失,对答切题,脑电图恢复正常,半月后乳房肿胀消退至正常。
1 case description The patient, male, 52 years old, more than 4 years after allogeneic kidney transplantation, due to renal insufficiency caused by progressive urinary protein and systemic edema admission. Persistent fever during hospitalization, left supraclavicular lymph nodes increased by biopsy and PCR testing, clinically diagnosed as “left supraclavicular lymph node.” Then with isoniazid anti-tuberculosis treatment. Hugh seizures: chronic disease, systemic edema, no abnormal heart and lung, pathological reflex did not lead. Laboratory tests: Hb 68g / L, WBC9.9 × 10-9 / L, urinary Pr (+++), SCr694μmol / L, CCr every 24 hours 6.92L, BUN31.9mmol / L, chol7.9mmol / L, A / G3.8 / 2.8, TG6mmol / L, SGPT18μ / L, K4.5mmol / L. Isoniazid (Guangdong Pharmaceutical Industry Company South China Pharmaceutical Factory production, batch number 940901), 0.3g, PO, qd. 1 week after the emergence of fantasy psychiatric symptoms, such as the total ward ceiling leakage, requiring room change; unresponsive, confused thinking, words are not satisfactory, the answer is irrelevant. Physical examination: swelling of the right breast, feminization of the male breast; mild pressure pain, but no lumps, the surface is not red, squeezed without latex spill. Auxiliary examination EEG abnormalities; vital signs and laboratory tests and medication before no significant change. 7d after the withdrawal of isoniazid abnormal psychiatric symptoms disappeared, answering questions, EEG returned to normal, half a month after the breast swollen subsided to normal.