Clinical Pathological Conference Ⅱ
Abstract of clinical history (A82013)
A 20-year-old female was admitted to the hospital on November 7, 1982, with a complaint of rigor and fever for about 6 days and delirium for about 3 days.
7 days before admission, the patient developed sore throat and cough , then suddenly got a high fever up to 40℃ with rigor. 3 days after that, the patient developed headache, delirium and slight paralysis of the right limb. Two days before admission, severe abdominal pain appeared but subsided one day later.
On examination the patient was well developed and moderately nourished, slight loss of consciousness.
PE: T 39℃, P 100/min, R 20/min, BP 120/80mmHg. Petechiae might be seen on the skin of the chest. There was resistance on the neck, dullness of the right lower lobe on percussion. The heart was not enlarged with regular rhythm. There was grade II blowing systolic murmur on the area of the pulmonary valve. The abdomen was soft, but slight tenderness on the upper part. Liver was 1cm below the costal margin. Spleen was not palpable. Tendon reflex was weakened but Kernig's and Babinski's sign were all positive.
Experimental findings:
WBC: 9400-11200, Polymorphs 72%, lymphocytes 24%, Basophils 2%, monocytes 2%
ESR: 26mm/first hr.
CO2CP: 16meq%.
Urine: Protein ++, RBC ++++, WBC 3-5, Cast (-).
Stool: OB ( ).
CSF: Protein 148mg%, Sugar 64.8%, and Chlorides 125meq%.
Total cells 23000, WBC 19800, PMN 90%.
Bacteria culture: (-).
Chest X-ray: small patched shadows occurred on the two lower lobes.
EKG: normal.
The patient still had fever and lost consciousness. The paralysis of right limb became severe and repeated occurring of upper abdominal pain. The heart murmur became pronounced and the heart rate being up to 120/min. 30days after admission, suddenly abdominal pain became severe and the patient fell into completed unconsciousness with irregular breathing. Finally stopped respiration and heart beat.