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患者男,35岁,因怕热、多汗、易饥6个月,全身红斑,瘙痒3d于2001年7月10日入院。患者于20d前在外院检查甲状腺功能,诊断为甲亢,给予甲巯咪唑(他巴唑)20mg bid、维生素B_4 20mg tid po治疗。3d前患者突然出现全身红斑,瘙痒,胸闷,气促。入院时查体:T 38.5℃,P 120次·min~(-1),BP 120/80 mmHg,全身皮肤湿润、多汗、可见大小不一的红斑、风团疹,均高出皮肤,划痕试验(+)。急查血象:WBC 1.6×10~9·L~(-1),N0.49,肝、肾功能检测无异常,血K~+ 2.06mmol·L~(-1)。入院诊断:甲亢(Graver病)、急性荨麻疹、低钾性麻痹。入院后,立即进行骨髓检查未见异常。停用甲巯咪唑,改用丙硫氧嘧啶150mg tid,普萘洛尔10mg tid po,粒细胞-巨噬细胞集落刺激因子(特尔立)75μg皮下注射qd×2天,琥珀酸氢化可的松 600mg+10％葡萄糖酸钙约20ml静滴,qd,同时补钾。2d后查血象:WBC 7.6×10~9·L~(-1),N 0.76,L 0.24,血K~+4.5×10~9mmol·L~(-1),
Male patient, 35 years old, due to fear of heat, sweating, easy to eat for 6 months, systemic erythema, itching 3d July 10, 2001 admitted. Patients in the hospital before the 20d check thyroid function, diagnosed as hyperthyroidism, given methimazole (methimazole) 20mg bid, vitamin B_4 20mg tid po treatment. Sudden onset of systemic erythema three days ago, itching, chest tightness, shortness of breath. Admission examination: T 38.5 ℃, P 120 times · min ~ (-1), BP 120/80 mmHg, systemic skin moist, sweating, showing different sizes of erythema, wind group rash, are higher than the skin, plan Mark test (+). Emergency blood test: WBC 1.6 × 10 ~ 9 · L ~ (-1), N0.49, liver and kidney function tests were normal, blood K ~ + 2.06mmol · L -1. Admission diagnosis: hyperthyroidism (Graver disease), acute urticaria, hypokalemia paralysis. After admission, no abnormal bone marrow examination immediately. Methimazole was discontinued, and propylthiouracil 150 mg tid, propranolol 10 mg tid po, and granulocyte-macrophage colony stimulating factor 75 μg subcutaneously qd x 2 days were used, and hydrogenated succinate Pine 600mg + 10% calcium gluconate about 20ml intravenous infusion, qd, while potassium. After 2 days, the blood samples were examined: WBC 7.6 × 10 ~ 9 · L -1, N 0.76, L 0.24, blood K + 4.5 × 10 9 mmol·L -1,