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患者男,50岁。因全身游走性疼痛2年,右上肢疼痛发作伴发热3天,于1992年6月29日入院。疼痛发作时局部红、肿、热,可触到黄豆大小皮下结节,伴发热,体温波动在36.9℃～39.3℃之间。每次发作持续时间约3～4天。可自行缓解。近半年发作次数频繁、间歇时间缩短,同时感头晕、乏力。曾多次到医院就诊,诊断不明。体检:T37.5℃,P92次/分。贫血貌,浅表淋巴结无肿大,心肺听诊无异常发现。腹软,肝肋下2.0cm、质中,脾肋下6.0cm、质偏硬、轻压痛,移动性浊音阴性。右前臂近腕关节处背侧可见2个大小约0.7cm×0.8cm皮下结节,质硬。 实验室检查:血Hb86g/L,WBC6.8×10~9/L,分类正常,血小板计数145X10~9/L,血沉80mm/h。抗核抗体、抗双链DNA、类风湿因子、抗“O”、尿酸、肝功能等均属正常范围。胸片无异常发现。CT检查示脾明显增大,肝内多发性囊肿。右前壁结节活检,病理诊断:脂膜炎伴血栓性静脉炎。
Male patient, 50 years old. Due to systemic walking pain for 2 years, right upper extremity pain episodes with fever for 3 days, on June 29, 1992 admission. Local red, swollen, hot when the pain attack, can touch the size of soybean subcutaneous nodules, with fever, body temperature fluctuations between 36.9 ℃ ~ 39.3 ℃. Each attack duration of about 3 to 4 days. Self-relieve. The frequency of seizures in the past six months, intermittent time shortened, dizziness, fatigue at the same time. Have repeatedly to the hospital for treatment, diagnosis is unknown. Physical examination: T37.5 ℃, P92 times / min. Anemia appearance, superficial lymph nodes without swelling, cardiopulmonary auscultation no abnormal findings. Abdomen soft, liver ribs 2.0cm, quality, spleen ribs 6.0cm, qualitative hard, light tenderness, mobility, voiced negative. Near the dorsal side of the right forearm near the wrist joints can be seen two about 0.7cm × 0.8cm size subcutaneous nodules, hard. Laboratory tests: blood Hb86g / L, WBC6.8 × 10 ~ 9 / L, normal classification, platelet count 145X10 ~ 9 / L, ESR 80mm / h. Anti-nuclear antibodies, anti-double-stranded DNA, rheumatoid factor, anti-“O”, uric acid, liver function, etc. are within the normal range. No abnormal chest X-ray findings. CT showed spleen increased significantly intrahepatic multiple cysts. Right front wall nodules biopsy, pathological diagnosis: lipid meningitis with thrombophlebitis.