病例介绍患者,男性,37岁,白种人,技工。自诉有风湿病来医院就诊。15年前他曾患有多发性关节炎,病程短暂,以后三年健康状况极好。发病不久开始有短期的关节炎发作,但发作从未严重到足以使他卧床不起。入院前两个月,他曾发生过右腕部柯勒氏骨折。后又有过左肩、臀、膝和踝关节炎的严重发作。此外,他自诉饭后有胃肠胀气,并感腹部肿胀。这些症状2～3年内断续出现,而且随进食过量和摄食油煎食物加重。入院前两年,他有过一次大约持续1周的无痛性黄疸。在这以后,他的腹部痛苦不适感加重。但食欲一直良好,唯进食较少,因为进食会使症状加重。在首次就诊时,他发现自己消瘦。检查有全身性色素沉着,在皮肤皱襞处更为明显。双眼正常,牙齿状况不好。颈、腋和腹股沟淋巴结肿大,甲状腺不肿大。双肺呼吸音清晰,心脏正常。腹部膨隆,柔软而有揉面感,肝脾不肿大,无腹水。除了所有的 Case Presentation Patient, male, 37 years old, Caucasian, mechanic. Private prosecution rheumatism to the hospital. He had multiple arthritis 15 years ago and had a short duration of illness. He was in excellent health for the next three years. Shortly after the onset of a short-term arthritis attack, but the seizures have never been serious enough to make him bedridden. Two months before admission, he had had a Corps’s fracture on his right wrist. After the left shoulder, buttocks, knees and ankle arthritis a serious attack. In addition, he complained of flatulence after a meal and swollen belly. These symptoms occur intermittently within 2-3 years, and with the over-eating and eating fried food aggravating. Two years prior to admission, he had had painless jaundice for about a week. After that, his abdominal pain and discomfort increased. But appetite has been good, only eat less, because eating can make the symptoms worse. At the first visit, he found himself wasting. Check the body pigmentation, wrinkles in the skin is more obvious. Normal eyes, bad teeth. Neck, axillary and inguinal lymph nodes, thyroid enlargement. Breath sounds clear lungs, the heart is normal. Abdominal bulge, soft and kneading surface, liver and spleen not swollen, no ascites. Except for all