误诊为急性扁桃体炎的传染性单核细胞增多症五例分析  

Analysis of Five Patients with Infectious Mononucleosis Misdiagnosed as Acute Tonsillitis

作　　者：郑辉乾 郑玉坤 赖宇涛 杨艺真 林茂增 ZHENG Huiqian;ZHENG Yukun;LAI Yutao;YANG Yizhen;LIN Maozeng(Department of Pediatrics,the 909th Hospital of Joint Logistics Support Force of the PLA/Southeast Hospital Affiliated to Xiamen University,Zhangzhou,Fujian 363000,China)

机构地区：[1]联勤保障部队第九〇九医院(厦门大学附属东南医院)儿科,福建漳州363000

出　　处：《临床误诊误治》2024年第17期8-11,共4页Clinical Misdiagnosis & Mistherapy

基　　金：2023年度福建省自然科学基金科技计划项目(2023J01543)。

摘　　要：目的探讨传染性单核细胞增多症(IM)的临床特点、误诊为急性扁桃体炎的原因及减少误诊的方法。方法回顾性分析2020年2月至2024年1月收治5例被误诊为急性扁桃体炎的IM患儿资料。结果3例因咽喉肿痛、发热2~4 d收治入院,2例因咽喉肿痛3~5 d、颈部肿胀疼痛2 d入院。5例均被误诊为急性扁桃体炎,误诊时间1~4 d。5例给予急性扁桃体炎对症支持治疗后未见好转,复查血常规,并行咽拭子培养和EBV抗体检测,最终确诊为IM。确诊后给予阿昔洛韦抗病毒等对症支持治疗后,患儿痊愈出院。结论IM的临床症状与急性扁桃体炎非常相似,容易被误诊。提高医师的临床思维能力及对IM的认知度,熟练掌握该病与急性扁桃体炎的鉴别诊断要点,并完善相关检查,有利于降低误诊率。Objective To investigate the clinical characteristics of infectious mononucleosis(IM),the causes of misdiagnosis as acute tonsillitis and the methods to reduce misdiagnosis.Methods The data of 5 IM children who were misdiagnosed with acute tonsillitis from February 2020 to January 2024 were retrospectively analyzed.Results Three patients were admitted to hospital with sore throat and fever for 2-4 d,and another 2 patients were admitted with sore throat for 3-5 d and neck swelling and pain for 2 d.All 5 patients were misdiagnosed with acute tonsillitis,and the misdiagnosis lasted 1-4 d.After receiving symptomatic supportive treatment for acute tonsillitis,5 patients did not improve,and IM was ultimately confirmed by reexamination of the blood routine,throat swab culture and EB virus antibody detection.After confirmed diagnosis and symptomatic supportive treatment such as antiviral drug Acyclovir,the children recovered and were discharged from hospital.Conclusion The clinical symptoms of IM are very similar to acute tonsillitis,and it is more likely to cause misdiagnosis.Improving doctors'clinical thinking ability and recognition of IM,mastery of the key points of differential diagnosis between IM and acute tonsillitis,and performance of relevant examinations are conducive to reducing the misdiagnosis rate.

关 键 词：传染性单核细胞增多症 误诊 急性扁桃体炎 儿童 咽拭子培养 EBV抗体检测 鉴别诊断 

分 类 号：R725.1[医药卫生—儿科]