患者男性,29岁,农民。因关节痛2个月,畏寒高热14天,头痛7天,神志不清2天于1984年7月14日入院。患者于入院前2个月左髋关节及两侧膝关节游走性疼痛,当地拟诊为“风湿性关节炎”,给服强的松40mg/日,症状缓解后逐渐减量为15mg/日,直至入院前3天停药。14天前突然畏寒、高热,体温达40℃,并感咽痛,无咳嗽。7天前出现头痛、恶心,无呕吐。2天前出现神志不清、谵妄、大小便失禁。既往无结核病史及其接触史。入院时体检:体温38.3℃,呼吸18次,脉搏88次,血压130/80mmHg。发育营养中等,神志矇眬, Male patient, 29 years old, farmer. Due to joint pain for 2 months, 14 days of chills and fever, headache for 7 days, confusion 2 days in July 14, 1984 admission. Patients in the left 2 months before admission and left knee and bilateral knee pain, local diagnosed as “rheumatoid arthritis,” to give prednisone 40mg / day, gradually reduced to 15mg / day after symptom relief , Until 3 days before admission withdrawal. 14 days ago suddenly chills, fever, body temperature up to 40 ℃, and flu sore throat, no cough. 7 days ago, headache, nausea, no vomiting. 2 days ago delirious, delirium, incontinence. No past history of tuberculosis and its history of exposure. Physical examination on admission: body temperature 38.3 ℃, breathing 18 times, pulse 88, blood pressure 130 / 80mmHg. Development of moderate nutrition, Meng Meng Meng,