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男,64岁。反复发热5年,踝关节肿痛,皮下结节2年入院。缘患者1986年来,反复高热寒战,历3～4小时后自然退热,每2～7天发作一次。近两年发热时四肢出现红色结节,伴两踝关节肿痛。此间,因“肝内胆管炎”、“胆囊炎”,行胆囊摘除术。体查:体温38.2℃。脉率96次/分。心肺无异,肝脾仅可及。两踝关节红、肿、压痛,右前臂及左股部有散在红结节,黄豆大小,有压痛。实验室检查:白细胞14.4×10_9/L,分类核左移。血沉57mm/h,抗“0”及类风湿因子阴性,γ-球蛋白48.1％。皮肤结节活检,镜下可见真皮血管及汗腺周围有大量以中性粒细胞为主的细胞浸润,白细胞
Male, 64 years old. Repeated fever for 5 years, ankle swelling and pain, subcutaneous nodules 2 years admitted. Edge patients since 1986, repeated high fever chills, natural cooling after 3 to 4 hours, every 2 to 7 days attack. In the past two years when the limbs appear red nodules, accompanied by two ankle joint swelling and pain. Here, due to “intrahepatic cholangitis”, “cholecystitis”, gallbladder removal surgery. Physical examination: body temperature 38.2 ℃. Pulse rate of 96 beats / min. Heart and lung is no different, liver and spleen only accessible. Two ankle joints red, swollen, tenderness, right forearm and left thigh scattered red nodules, soy size, tenderness. Laboratory tests: white blood cells 14.4 × 10_9 / L, classification of the left shift. ESR 57mm / h, anti “0” and rheumatoid factor-negative, γ-globulin 48.1%. Skin nodules biopsy, microscopic examination of dermal blood vessels and sweat glands around a large number of neutrophil-based cell infiltration, white blood cells