title: Crohn's disease complicated by adult-onset Still's disease.
abstract: A 31-year-old man with Crohn's disease developed arthritis, spiking fever, and skin rash indistinguishable from that of adult-onset Still's disease. He was admitted to our hospital because of a periumbilical intestinal skin fistula. Crohn's disease had been diagnosed in 1991, and had required intestinal resection twice, and schizophrenia had been diagnosed in 1993. He developed polyarthritis and spiking fever, accompanied by a macular skin rash on both forearms. Marked hepatosplenomegaly and bilateral pleural effusion were detected on computed tomography examination. These findings are indistinguishable from those of adult-onset Still's disease. Because his mental status had deteriorated following high-dose prednisolone on a previous admission, he was treated with an immunosuppressive agent on this occasion, with the treatment being successful. This is the first report of adult-onset Still's disease complicating Crohn's disease. In patients with Crohn's disease, polyarthritis and skin rash can easily be misdiagnosed as enteropathic arthritis with erythema nodosum associated with the Crohn's disease. Although adult-onset Still's disease may not be fatal, early diagnosis is important because it can, in rare cases, result in life-threatening complications.
authors.affiliation: Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
authors.forename: Mizuki
authors.initials: M
authors.lastname: Kono
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Oshitani
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Sawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Watanabe
authors.forename: Noriko
authors.initials: N
authors.lastname: Kamata
authors.forename: Ryuta
authors.initials: R
authors.lastname: Oiso
authors.forename: Makoto
authors.initials: M
authors.lastname: Inagawa
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kawachiya
authors.forename: Daichi
authors.initials: D
authors.lastname: Kawashima
authors.forename: Mitsue
authors.initials: M
authors.lastname: Sogawa
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Jinno
authors.forename: Kenji
authors.initials: K
authors.lastname: Watanabe
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Arakawa
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000150:complications*; D006801:Humans; D008297:Male; D016706:Still's Disease, Adult-Onset / Q000209:etiology*