病例1,女性,14岁,因潮热盗汗四肢关节游走性疼痛24天,外院诊断为“风湿热”,给以青霉素、阿斯匹林、强的松治疗12天无好转,发热、关节痛加重伴咳嗽气促5天门诊胸透提示血行播散型结核收住我院。查体:体温39.6℃,咽红,双肺可闻细湿罗音。双膝关节右髂关节红肿明显,右膝关节灼热有波动感,活动受限。右膝关节囊穿刺抽出35ml黄色粘液。送检蛋白(+)、白细胞360个、培养无细菌生长。化验及辅助检查:白细胞11.2×10~9/L、中性79％、淋巴21％、血沉104mm/h、抗“O”400U、类乳试验(-)。胸片示双肺满布密度均匀、大小相等粟粒样阴影。膝关节片正常。痰涂找抗酸杆菌3次(++)。入院诊断:①结核风湿症。②急性血行播散型肺结核。经抗痨治疗14天体温恢复正常。1月后髋关节、左膝关节红肿消失。右膝 Case 1, female, 14 years old, because of hot flashes Sweat sweat limbs joint pain walking for 24 days, outside the hospital diagnosed as “rheumatic fever” to give penicillin, aspirin, prednisone 12 days without improvement, fever, joint Pain aggravated with cough and breath 5 days out of chest thoracotomy prompted blood disseminated tuberculosis admitted to our hospital. Physical examination: body temperature 39.6 ℃, throat red, lungs can smell fine wet rales. Right knee joint swelling of the right iliac joint obvious, right knee joint burning sensation of fluctuation, limited activity. Right knee capsule puncture 35ml yellow mucus. Inspection of protein (+), 360 white blood cells, culture-free bacterial growth. Laboratory and auxiliary examination: white blood cells 11.2 × 10 ~ 9 / L, neutral 79%, lymph 21%, erythrocyte sedimentation rate 104mm / h, anti “O” 400U, milk test (-). Chest radiograph shows lungs covered with uniform density, equal size, miliary shadows. The knee joint is normal. Phlegm looking for acid-fast bacilli 3 times (++). Admission diagnosis: ① tuberculosis rheumatism. ② acute hematogenous disseminated pulmonary tuberculosis. After anti-tuberculosis treatment for 14 days the body temperature returned to normal. After January hip, left knee joint swelling disappear. Right knee