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1 病例报告患者男,60岁,因发热伴关节疼痛4个月于1994年1月12日入院.4个月前受凉后出现咳嗽、发热.当地医院以“肺炎”诊治,用药及剂量不详,症状无缓解,并呈进行性加重,体温高达39℃,无明显盗汗.咳白色粘液样痰,无咳血.转省结核病医院治疗3个月.效果仍不佳,且关节疼痛、酸胀明显.遂来我院门诊以成人Still’s病收住院.平素无吸烟及慢支病史.查体:慢性病容,皮肤发暗,弹性差.胸锁乳突肌后缘、腋下、腹股沟及右侧肘后淋巴结肿大,质中等,孤立,大小不一.舌苔薄白,舌缘可见齿痕,咽部轻度充血.两肺呼吸音粗,肺底可闻及细湿性罗音.左侧胸膜摩擦音.心尖搏动弥散约3cm×5cm,未触及震颤;心脏向左上扩大,心率80次/分,律齐,A_2>P_2,三尖瓣区可闻及Ⅱ～Ⅲ级收缩期吹风样杂音,未闻及心包摩擦音.腹平软,肝脏于肋下4cm,质中等,边缘锐利,无结节及包块,脾肋下3cm,质中等,压痛阳性.
A case report Male, 60 years old, due to fever with joint pain for 4 months on January 12, 1994 admission .4 months ago, cough, fever after the cold. Local hospital diagnosis and treatment of pneumonia, medication and dose unknown, Symptoms without remission, and was progressive increase in body temperature as high as 39 ℃, no obvious night sweats .Clear mucus-like sputum, no coughing blood .To save the hospital for 3 months TB treatment. The effect is still poor, and joint pain, soreness obvious Then came to our hospital outpatient adult Still’s disease admitted to hospital .Physiological history of non-smoking and chronic bronchitis. Physical examination: chronic disease, dark skin, poor elasticity .Sternocleidomastoid margin, underarm, groin and right elbow After the lymphadenopathy, medium quality, isolated, different sizes. Thin white tongue, tongue edge visible tooth marks, mild throat congestion. Two lungs sound of coarse sound, lung bottom can be heard and fine wet rales. Left pleural friction .Apex beat dispersion of about 3cm × 5cm, did not touch the tremor; heart enlargement to the left, heart rate 80 beats / min, law Qi, A_2> P_2, tricuspid valve area can smell and Ⅱ ~ Ⅲ systolic hair blowing noise, And pericardial frictional sound. Abdomen soft, liver in the ribs 4cm, medium quality, sharp edges, no nodules and mass, Spleen 3cm, medium quality, pressure Positive.