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例1,男,51岁。因关节疼痛半月入院。入院前半月患者始现关节疼痛,以双下肢大关节为主,呈游走性且活动受限,伴低热,盗汗等。查体:体温38℃,皮肤未见环形红斑和皮下结节,腹软,肝脾肋下未触及,双下肢大关节无明显红肿,但活动受限。化验:WBC9.2 ×10~9/L,中性粒细胞0.75,Hb103g/L,SR60mm/h。初步诊断:风湿性关节炎。给予青霉素、阿斯匹林、激素等治疗2月余无效。体温在37.5～38.5℃之间,关节疼痛无改善。并发现侧卧位脾脏肋下刚及,骨髓涂片先后7次检查正常,第八次骨髓涂片发现利杜体,确诊为黑热病。给予葡萄糖酸锑钠治疗后,关节疼痛消失。体温恢复正常。例2,女,40岁。因关节疼痛伴发热1月入院。1月前患者始现关节疼痛,以肘膝关节为主,呈游走性,伴发热,查体:体温38.2℃,肝肋下未
Example 1, male, 51 years old. Half-month hospitalization due to joint pain. Half a month before admission, patients with joint pain, mainly to the lower extremity joints, was walking and limited mobility, with fever, night sweats and so on. Physical examination: body temperature 38 ℃, the skin no annular erythema and subcutaneous nodules, abdominal soft, liver and spleen ribs untouched, no obvious swelling of the lower extremity joints, but the activity is limited. Laboratory tests: WBC9.2 × 10 ~ 9 / L, neutrophils 0.75, Hb103g / L, SR60mm / h. Initial diagnosis: rheumatoid arthritis. Give penicillin, aspirin, hormones and other treatment more than 2 months invalid. Body temperature between 37.5 ~ 38.5 ℃, no improvement in joint pain. And found that the spine just lateral ribs and spleen, bone marrow smear has seven normal check, the eighth bone marrow smear found Leti body, diagnosed as kala-azar. Arthritis pain disappeared when treated with antimony gluconate. Body temperature returned to normal. Example 2, female, 40 years old. Because of joint pain with fever in January hospitalization. 1 month ago, patients with joint pain, elbow knee-based, was migratory, with fever, physical examination: body temperature 38.2 ℃, under the liver ribs