摘要To the editor:A female patient,aged 49,visited the emergency room at Beijing Union Medical College Hospital on August 21,2013.She had had "malaise for five years,aggravated for more than a month with fever." Since early 2008,the patient had whole body fatigue without a cause,but it was not affecting her daily work.As the symptoms gradually worsened,she became incapable of daily chores and had difficulty climbing stairs to the second floor.Two years ago,she resigned from work to rest at home,but the symptoms of fatigue aggravatedand she was reluctant to get out of bed.One month ago,the patient accidentally fell from her bed due to fatigue and she was only able to get up with help from family.Since then,the patient started to have fever (self-measured temperatures up to 38-39℃) and dizziness.Self-prescribed antipyretic drugs did not have an effect on reducing the fever.She did not sweat,but her body temperature decreased slightly after a warm sponge bath.She could not walk,comb her hair,or go to the bathroom by herself.She had intermittent palpitations,dizziness,and loss of appetite,with normal urine and bowel movements,and no other discomfort.On August 20,2013,the patient's temperature increased to 41.6℃,she then came to our hospital emergency room for further treatment.