以持续性中、高热为首要表现的痛风急性发作1例报告及文献复习

目的：分析以持续性中、高热为首发症状的痛风急性发作患者的临床诊治方法，以提高临床医生对以持续性中、高热为首要表现的痛风急性发作的认识。方法：收集1例不明原因发热老年男性患者的临床资料，并结合文献复习，探讨该病的诊断和治疗方法。结果：患者以"持续性发热4d"入院，血常规检查示白细胞计数明显升高，胸部CT示左肺下叶炎症，给予积极抗感染治疗10 d，患者发热症状无明显缓解，白细胞计数仍明显高于正常水平，全面的实验室检查和影像学检查均未见引起发热的阳性结果。患者查体见双足痛风结节，血尿酸水平明显升高，结合患者既往痛风病史，给予试验性抗痛风治疗；治疗2周后，患者发热症状逐渐缓解，白细胞计数和尿酸水平逐渐恢复正常，考虑发热原因为痛风急性发作。结论：对于不明原因发热，尤其是中、高度热型患者，如系统抗感染治疗效果不好，应考虑痛风急性发作。

Acute gout attack with persistent medium and high fever as first manifestation:A case report and literature review

Objective:To analyze the diagnosis and treatment methods of one acute gout attack patient with persistent medium and high fever as the first manifestation, and to improve the understanding of the clinicians for acute gout attack with persistent medium and high fever as the first manifestation. Methods:The cliniccal data of an elderly male patient with fever of unknown cause was collected; the literature review was perfomed and the diagnosis and treatment methods of the disease were explored. Results:The patient was admitted to hospital because of persistent fever for 4 d. The count of white blood cells in the routine blood test was high and the left lower lobe inflammation was found in the chest CT scanning. The patient was given the active anti-infection treatment for 10 d,but there was no obvious relief of fever manifestation, and the count of white blood cells remained the high level; no positive results inducing fever were found through comprehensive laboratory examinations and imageological examination. The gout nodules on both feet of the patient were found by physical examination and the level of uric acid was high, so the patient was given experimental anti-gout treatment combined with his previous history of gout. The patient's fever manifestation gradually relieved, the count of white blood cells in routine blood test and the level of uric acid were gradually decreased to the normal levels. The acute gout attack was considered as the cause of fever. Conclusion:For the patients with fever of unknown cause, especially with medium and high fever, if the systematic anti-infection treatment is not effective,the possibility of acute gout attack should be considered.