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男性,37岁,农民。因间歇性畏寒、发热、双膝关节酸痛12天而于1996年5月8日入院。患者3天前无明显诱因出现畏寒、发热,晚上体温较白天高,体温最高达39.8°C,伴咽喉痛及两膝关节酸痛。按“上感”治疗,疗效不佳。体检:T38°C,精神稍软,躯干皮肤可见散在分布的充血性点状小丘疹。右颈后多个淋巴结肿大,质中,无触痛,最大1.0cm × 0.8cm。咽后壁明显充血,两侧扁桃腺无肿大。心肺听诊正常。腹平软,无压痛及反跳痛,肝肋下及,边缘锐,表面光滑,质软,轻度触痛。侧卧位脾肋下及2cm,边圆钝,表面光滑,质中等,无触痛。四肢大关节无红肿热痛,运动自如。血WBC19.2×10~9/L,N 0.89,L0.11。血沉72mm/h,肥达反应阴性,抗“O”250U,类风湿因子及C反应蛋白均阴性,粘蛋白29mg/L。3次血培养均阴性,骨髓涂片呈感染象,骨髓培养阴性。B超示脾稍增厚。CT检查示脾肿大,慢性胆囊炎征象。入院后先后予青霉素、泰星、环丙沙星、菌必治及灭滴灵等抗炎、支持及对症处理。患者入院第2天体温降至正常,双膝关节酸痛等症状缓解。但此后分别间隔6～8天,体温间歇升高2次,每次持续2～8天,血象仍高,血沉升至96mm/h,予足量抗生素治疗
Male, 37 years old, farmer. Due to intermittent chills, fever, knee pain for 12 days and on May 8, 1996 admitted. The patient had no obvious cause of chills and fever 3 days ago. At night, her body temperature was higher than that during the day. The body temperature reached 39.8 ° C with sore throat and two knee joints. Press “sense” treatment, poor efficacy. Physical examination: T38 ° C, the spirit of a little soft, visible torso skin scattered congestive dot-shaped papules. Right after multiple neck lymph nodes, quality, no tenderness, the largest 1.0cm × 0.8cm. Pharynx posterior wall hyperemia, no swelling on both sides of the tonsils. Cardiopulmonary auscultation normal. Abdomen soft, no tenderness and rebound tenderness, liver ribs and edge sharp, smooth, soft, mild tenderness. Side of the spleen and ribs 2cm, side blunt, smooth, medium quality, no tenderness. No swelling and pain in limbs joints, exercise freely. Blood WBC19.2 × 10 ~ 9 / L, N 0.89, L0.11. ESR 72mm / h, WADA negative, anti “O” 250U, rheumatoid factor and C-reactive protein were negative, mucin 29mg / L. 3 blood cultures were negative, bone marrow smear infection, bone marrow culture negative. B ultrasound showed thickening of the spleen. CT examination showed splenomegaly, signs of chronic cholecystitis. After admission to penicillin, Thailand Star, ciprofloxacin, bacteria must rule and metronidazole anti-inflammatory, support and symptomatic treatment. On the second day after admission, the body temperature dropped to normal, and symptoms such as sore knees were relieved. However, after an interval of 6 to 8 days, body temperature increased intermittently 2 times, each lasting 2 to 8 days, the blood is still high, ESR rose to 96mm / h, adequate antibiotic treatment