(Disclaimer: This article is only for popular science purposes, in order to protect the privacy of patients, the following content of the relevant information has been processed) Abstract: The patient because of colds and recurrent cough for 10 days, the first cough, cough sputum did not pay attention to, thought that is suffering from colds, 5 days ago there is a fever, mostly low-grade fever, so come to the Chest Hospital, exclude pulmonary tuberculosis, seeking further diagnosis and treatment to our hospital. The patient was admitted to the hospital and was diagnosed with pulmonary tuberculosis by puncture lymph node biopsy. The patient was given hormone therapy, and her symptoms were gradually relieved. Basic information] Female, 18 years old [Type of disease] Nodular disease [Hospital] The Second Affiliated Hospital of Harbin Medical University [Date of consultation] April 2021 [Treatment plan] Surgery (trans-tracheoscopic ultrasound-guided needle aspiration biopsy) + hormone therapy (injectable methylprednisolone sodium succinate, prednisone acetate tablets) [Treatment cycle] 10 days of hospitalization, 1-month outpatient follow-up [Treatment effect] The disease has been controlled. The patient was hospitalized for 10 days and followed up in outpatient clinic for 1 month. The disease was under control I. Initial Consultation The patient coughed repeatedly for 10 days because of cold and flu, and did not pay attention to the cough and sputum in the beginning, thinking that he was suffering from cold and flu, and took various antibiotics by himself, such as amoxicillin capsule and azithromycin tablets, etc., and the symptoms did not decrease significantly. 5 days ago, he had fever, and the highest temperature was 38℃, mostly low fever, and the patient feared that he was suffering from pulmonary tuberculosis, and therefore came to the chest hospital. He was worried that he was suffering from tuberculosis, so he came to the Chest Hospital for further diagnosis and treatment, but his fever did not decrease and he had enlarged lymph nodes in his neck. After asking about his medical history, the patient asked me if he was worried about tuberculosis, and then a CT examination of the lungs was performed, which showed multiple nodules in the lungs and multiple enlarged lymph nodes in the mediastinum. According to the patient’s age and medical history and imaging, it was inclined to nodular disease, so he was admitted to the hospital for treatment. Physical examination: temperature 38.0°C, pulse 108 beats/min, respiration 22 beats/min, blood pressure 120/70 mmHg, heart rate 108 beats/min. Chronic disease appearance, lips and skin without cyanosis, the right neck can be touched with enlarged lymph nodes, viability is good, no pressure pain, no dry or wet rales in both lungs, heart rhythm is Qi, the abdomen is not bulging, liver and spleen are not touched with enlargement. The patient had been ill for 10 days, and the symptoms were not relieved by oral antibiotics. Because of low fever, she was once thought to have tuberculosis and was admitted to the Chest Hospital, where she was given anti-tuberculosis treatment and relevant examinations to exclude tuberculosis, and was admitted to the department because of fever and worsening of symptoms of fatigue. In the outpatient clinic perfect lung enhancement CT return: do not exclude lymphoma, after admission to the hospital to give symptomatic treatment, performed trans-tracheoscopic ultrasound-guided needle aspiration biopsy, pathology excluded tumor, a small amount of powder necrosis and individual lymph nodes. The pathology did not report granulomatous changes typical of nodal disease, but still favored nodal disease based on the patient’s symptoms. Hormonal therapy (injectable methylprednisolone sodium succinate, prednisone acetate tablets) was given for 1 week and the patient was discharged. It was recommended that the patient should be re-examined after 1 month for a follow-up of lung CT, and the patient was instructed to consult the doctor at any time if he felt unwell. The patient thought it was a cold at the beginning and took many kinds of antibiotics without effect, then due to the aggravation of symptoms and fever, he was admitted to the Chest Hospital for anti-tuberculosis treatment, and the symptoms were slowly progressing, and there were swollen lymph nodes in the neck, and then he came to our hospital and was diagnosed as nodular disease. Hormone therapy was given, and after the medication, the fever and cough symptoms were quickly reduced, and in the follow-up lung CT 1 month later, the lung images were almost completely absorbed, and the lymph nodes were significantly reduced in size (see the following figure). The patient was advised to reduce the dosage gradually and review regularly to avoid recurrence. Lungs: no multiple nodular shadows were seen Mediastinal lymph nodes were clearly shrunk and disappeared IV. Precautions We are glad that the patient’s symptoms have improved after treatment, but remind the patient to pay attention to the following aspects in the course of treatment: 1. Most patients with tuberculosis can be relieved on their own, and those with stable and asymptomatic conditions in Stage Ⅰ and Stage Ⅱ do not need to be treated. However, the patient’s lungs and cervical lymph nodes have been involved, this patient has obvious symptoms, belonging to stage Ⅲ patients so need to apply hormone therapy, commonly used prednisone 4 weeks after the gradual reduction of dosage, maintain 1 year or longer continuous treatment. Long-term use of hormone drugs should be closely observed hormone side effects; 2, nodular disease is easy to relapse, many people can be relapsed after 1 year of treatment, so inform the patient, regular use of medication, the dosage reduction process, to observe whether there is fever, dyspnea and other symptoms, if the drug recurrence, the need for re-diagnosis, can be used to choose the methotrexate tablets and other treatments; 3, discharged from the hospital, a light diet, eat easily digestible food. As the active period of the disease can have elevated blood calcium, thus the patient’s diet should be appropriately limited to foods and drugs with high calcium content, such as soybean products, dairy products, sesame paste, calcium tablets and so on. V. Personal perception: nodular disease is a non-caseous necrotizing epithelial granulomatous inflammatory disease with unknown etiology. It mainly affects the lung parenchyma, and may involve many organs in the body, such as lymph nodes, skin, joints, liver, kidneys, and heart, etc. The clinical process of nodular disease is mostly chronic, and it is easy to misdiagnose as tuberculosis or lymphoma when it affects the lung tissue or lymph nodes. The clinical course of nodal disease is characterized by a variety of manifestations, which are related to the urgency of the onset of the disease, the different organs involved, and the activity of the granuloma. Acute nodal disease is characterized by bilateral hilar lymph node enlargement, arthritis, and erythema nodosum. About 1/3 of the patients often have non-specific manifestations, i.e., systemic symptoms, such as low-grade fever, weight loss, absence of fatigue, and night sweats, which are easy to be misdiagnosed as tuberculosis, and the majority of the patients have spontaneous remission within 1 year. Subacute or chronic nodular disease, about 50% of nodular disease is asymptomatic, for physical examination occasionally found. Nodal disease involving the lungs and mediastinal lymph nodes is the most common, with insidious clinical manifestations. 30%-40% of extrathoracic nodal disease can be palpable lymph nodes are enlarged, not fused, with good mobility and no tenderness. This patient presents with enlarged cervical lymph nodes with good mobility, so although imaging considerations do not exclude malignant lymphoma, the clinical predisposition is for benign disease.