误诊为化脓性扁桃体炎的五例传染性单核细胞增多症原因分析  

Analysis of 5 Cases with Infectious Mononucleosis Misdiagnosed as Suppurative Tonsillitis

作　　者：袁娟[1] 谢燕[1] 王小燕[1] 张瑜[1] 邓慧玲[1] YUAN Juan;XIE Yan;WANG Xiao-yan;ZHANG Yu;DENG Hui-ling(Department of Infectious Diseases,Xi'an Children's Hospital,Xi'an 710003,China)

机构地区：[1]西安市儿童医院感染科,西安710003

出　　处：《临床误诊误治》2020年第6期1-5,共5页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省科技统筹创新工程计划项目(2016TZC-S-15-8)。

摘　　要：目的分析传染性单核细胞增多症误诊为化脓性扁桃体炎的原因,降低临床误诊率。方法回顾性分析误诊为化脓性扁桃体炎的传染性单核细胞增多症5例临床资料。结果本组因发热、咽痛4 d就诊1例;因咽痛、发热、畏寒3 d就诊1例;因咽痛、眼睑水肿伴发热2 d就诊1例;因咽痛6 d,加重伴发热、头痛3 d就诊1例;因咽痛、颈部肿胀疼痛7 d就诊1例。5例均误诊为化脓性扁桃体炎,误诊时间1~3(2.1±0.5)d。入院后均予对症处理,症状未见好转,后经EB病毒抗体检测、DNA检查等确诊为传染性单核细胞增多症,确诊后予抗病毒及支持治疗后痊愈出院。结论传染性单核细胞增多症可出现扁桃体增大、咽痛、发热等症状,易与化脓性扁桃体炎相混淆,提示临床遇及治疗效果不佳的患儿时应进行全面综合检查,加强对传染性单核细胞增多症的诊断及鉴别诊断,以降低误诊率。Objective To analyze the causes of misdiagnosis of infectious mononucleosis as suppurative tonsillitis and to reduce the rate of misdiagnosis.Methods The clinical data of 5 cases with infectious mononucleosis misdiagnosed as suppurative tonsillitis were retrospectively analyzed.Results In this group,one patient presented to our hospital because of fever and sore throat for 4 days.One patient was admitted to the hospital because of sore throat,fever and chills for 3 days.One patient was admitted because of sore throat and palpebral oedema with fever for 2 days.One patient was admitted to the hospital because of sore throat for 6 days which was aggravated with fever and headache for 3 days.One patient was admitted to the hospital because of sore throat and neck swelling and pain for 7 days.They all were misdiagnosed as suppurative tonsillitis.The duration of misdiagnosis was 1-3(2.1±0.5)d.They were treated with symptomatic treatment after admission,and the symptoms did not improve.They were subsequently diagnosed as infectious mononucleosis by Epstein-Barr virus antibody and DNA test.After the diagnosis,they were given antiviral and supportive treatment and were discharged from hospital after recovery.Conclusion Infectious mononucleosis can show some symptoms such as enlargement of tonsils,sore throat and fever,which are more likely to be misdiagnosed as suppurative tonsillitis.It is recommended that children with poor therapeutic effect in clinical settings should be comprehensively examined,and the diagnosis and differential diagnosis of infectious mononucleosis should be strengthened to reduce the rate of misdiagnosis.

关 键 词：传染性单核细胞增多症 误诊 扁桃体炎 发热 咽 疼痛 

分 类 号：R512.7[医药卫生—内科学]