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患者男,17岁,因尿频、尿痛、尿道口溢脓,龟头、尿道口旁各有一个黄豆大浅溃疡(图1),双侧腹股沟淋巴结肿大就诊。眼结膜充血伴脓性分泌物。双膝关节及左踝部肿痛。胸腹部密布、四肢近端散在绿豆大出血性丘疱疹,疹中央有小米粒大脓疱或结痂,痂外绕以苍白色水肿性环,环外有红晕(图2,3)。实验室检查：白细胞16．9×10~9/L,中性粒细胞0．754．淋巴细胞0．168,单核细胞0．076,嗜酸粒细胞0．002；红细胞4．98×10~(12)/L．血细胞沉降率58 mm/1h。尿常规及沉渣,潜血(+),红细胞0～2/HP,白细胞10～20/HP,上皮细胞1～3/HP,细菌(+)。IgG、IgA、C3正常。IgM降低,C_4增高,类风湿因子、ASO正常,C反应蛋白升高。尿道口脓液涂片、膝关节腔穿刺液涂片革兰染色均在中性粒细胞内发现大量革兰阴性双球菌(图4)。膝关节腔穿刺液(巧克力血琼脂平皿加CO_2)淋球菌培养,结果阳性,菌落呈类圆形水滴样半透明小凸起,直径约0．5 mm。将菌落挑出涂片革兰染色,为革兰阴性
The patient, male, 17 years old, had a soy sauce ulcer (Fig. 1) due to frequent urination, dysuria, urethral pus, glans and urethra, and bilateral inguinal lymph nodes. Conjunctival hyperemia with purulent discharge. Both knees and left ankle swelling and pain. Chest and abdomen are dense, near the extremities scattered mung bean hemorrhagic mound herpes, rashes central millet pustules or crusts, scabs around the pale edema ring, the ring outside the flush (Figure 2,3). Laboratory tests: white blood cells 16.9 × 10 ~ 9 / L, neutrophils 0.754. Lymphocytes 0.168, monocytes 0.076, eosinophils 0.002; red blood cells 4.98 × 10-12 / L. Blood cell sedimentation rate 58 mm / 1h. Urine and sediment, occult blood (+), red blood cells 0 ~ 2 / HP, white blood cells 10 ~ 20 / HP, epithelial cells 1 ~ 3 / HP, bacteria (+). IgG, IgA, C3 normal. IgM decreased C_4 increased rheumatoid factor, ASO normal C-reactive protein increased. Urethral pus smear, knee joint puncture smear Gram stain were found in a large number of neutrophils Gram-negative meningitis (Figure 4). Knee cavity puncture fluid (chocolate blood agar plate plus CO_2) Neisseria gonorrhoeae culture, the result was positive, the colony was round water droplets translucent small protrusions, a diameter of about 0.5 mm. The colonies were picked out smear Gram stain, negative for Gram