title: [Clinical thinking and decision making in practice. A young woman with fever, arthralgia and exanthema].
abstract: A 19-year-old woman was admitted because of high fever, rash, arthralgia and sore throat. On physical examination a diffuse skin rash was observed, leaving a facial mask unaffected. C-reactive protein and erythrocyte sedimentation rate were raised (114 mg/l and 26 mm in the first hour, respectively); white blood cell count was normal (6.2 x 10(9)/l) with an increased count of immature forms. An infective, metabolic or haematological cause was excluded. Serum ferritin turned out to be extremely elevated (4318 micrograms/l), so adult-onset Still's disease was diagnosed. The patient fulfilled the criteria of Cush et al. for adult-onset Still's disease. She was first treated with non-steroidal anti-inflammatory drugs (NSAIDs) and, at a later stage in the disease, with corticosteroids. All symptoms disappeared and blood test results normalised.
authors.affiliation: Afd. Interne Geneeskunde, Medisch Centrum Rijnmond-Zuid, locatie Zuider, Groene Hilledijk 315, 3075 EA Rotterdam.
authors.forename: E
authors.initials: E
authors.lastname: van Meerten
authors.forename: A
authors.initials: A
authors.lastname: Berghout
authors.forename: W D H
authors.initials: WD
authors.lastname: Hendriks
authors.forename: A J G
authors.initials: AJ
authors.lastname: Swaak
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018771:Arthralgia / Q000209:etiology; D002983:Clinical Competence; D003657:Decision Making; D003937:Diagnosis, Differential; D005076:Exanthema / Q000209:etiology; D005260:Female; D005293:Ferritins / Q000097:blood; D005334:Fever / Q000209:etiology; D006801:Humans; D016706:Still's Disease, Adult-Onset / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005293:Ferritins