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病历摘要患者女性,42岁,工人,住广州黄埔某公司宿舍。因发热11天,少尿3天于1986年7月3日入院。病前数日,患者发现左背侧皮肤有一红色丘疹,不痛。用鱼石脂软膏外敷,后发生溃疡,上复盖黑色痂皮。随后觉畏寒发热,按感冒治疗无效,体温波动于38℃～40℃之间,伴头痛、腰痛、听力减退。轻度咳嗽,吐少量黄痰,无咯血及胸痛。食欲差,曾恶心呕吐数次,吐出胃内容物。小便正常,大便较硬。发热第6天到某职工医院就诊,查白细胞11,750,中性粒细胞77%;尿蛋白(+～+++)。胸透示右下肺部感染。肝功检查谷-丙转氨酶(GPT)300单位。给予青、链、氯、红霉素治疗,体温略下降。入院前3天,患者突然尿量明显减少,同时出现颜面及下肢浮
Patient, 42, worker, living in a corporate dormitory in Guangzhou Huangpu. Due to fever for 11 days, oliguria 3 days in July 3, 1986 admission. A few days before the illness, the patient found a red papule on the left dorsal skin, not painful. With fish grease ointment topical ulcers, covered with a black crust. Then feel chills fever, according to the cold treatment is invalid, body temperature fluctuations between 38 ℃ ~ 40 ℃, with headache, back pain, hearing loss. Mild cough, spit a small amount of yellow sputum, no hemoptysis and chest pain. Poor appetite, vomiting nausea several times, spit stomach contents. Normal urine, stool is harder. Fever 6 days to a staff hospital for treatment, check leukocytes 11,750, 77% of neutrophils; urinary protein (+ ~ +++). Chest show right lower lung infection. Liver function tests valine-aminotransferase (GPT) 300 units. Given green, chain, chlorine, erythromycin treatment, body temperature decreased slightly. Three days before admission, the patient suddenly decreased urine output, while facial and lower limbs float