[Clinical thinking and decision making in practice. A young woman with fever, arthralgia and exanthema].
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.
van Meerten
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E
Afd. Interne Geneeskunde, Medisch Centrum Rijnmond-Zuid, locatie Zuider, Groene Hilledijk 315, 3075 EA Rotterdam.
Berghout
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A
Hendriks
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WD
Swaak
A J G
AJ
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
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005293:Ferritins