临床病例评析——关节炎发热喘憋

Arthritis, fever, and wheeze

目的探索类风湿关节炎（RA）患者合并发热和肺部病变的诊断和鉴别诊断方法的要领。方法对1例55岁，出现关节炎、发热和喘憋的男性患者进行详尽的临床诊治分析。结果患者的关节表现符合RA，经过肺高分辨率CT进行肺部空洞的鉴别诊断，并经过试验性抗真菌治疗的验证，最后确定诊断为RA合并肺间质病变和真菌感染。结论RA患者出现发热和肺部空洞性病变要考虑到肺真菌感染的可能性。

Objective To explore the diagnostic and differential diagnostic points in a patient with rheumatoid arthritis （RA） complicated with fever and pulmonary diseases. Methods Full clinical analysis was performed for a 55-year old patient with arthritis, fever, and wheeze. Results The clinical pictures of the patient were consistent with those of RA. Computed tomograpby （CT） revealed interstitial lung diseases and intrapulmonary cavities. Antifungal agents were given experimentally, and the intrapulmonary cavities disappeared finally, thus the patient was diagnosed as RA, concurrently complicated with interstitial lung disease and pulmonary fungal infection. Conclusion The possibility of pulmonary fungal infection should be considered in RA patients who presented with fever and intrapulmonary cavities.