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【简答题】
×,男,12岁,汉族,未婚,江西宁都人。因发热伴左侧面颊肿痛2天于2005年1月14日入院。 1月12日起无诱因发热,体温38~40℃,明显畏寒、寒战,并有左侧面颊肿痛。 体查:体温38℃,脉搏86次/分,呼吸20次/分,巩膜无,双颌下见数个蚕豆大小淋巴结,质中偏硬,无压痛,界清,移动可。无皮疹、咽充血,扁桃体不大,左侧面颊以耳垂为中心,、后、下发展,状如梨形,边缘不清(如图);局部皮肤紧张,发亮但不发红,触之坚韧有弹性,有轻触痛;言语、咀嚼(尤其进酸性饮食)时刺激唾液分泌,导致疼痛加剧,双肺呼吸,腹无压痛,肝肋下未及,脾肋下未及。 血常规:白细胞6.5×10 9 /L,中性粒细胞0.45,淋巴细胞0.55,血色素156g/L,血小板256×10 9 /L。 请提出主要诊断及依据与主要鉴别诊断。
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