title: Urticaria as a cutaneous sign of adult-onset Still's disease.
abstract: BACKGROUND
  The cardinal signs and symptoms of adult-onset Still's disease (AOSD) include periodic fever, arthralgia and arthritis, lymphadenopathy, hepatosplenomegaly, an evanescent rash accompanied by neutrophilic granulocytosis, and a negative rheumatoid factor and antinuclear antibody test.
  
  
  OBJECTIVE
  To alert clinicians and dermatologists to internal diseases such as AOSD when assisting patients with urticarial eruptions and systemic symptoms.
  
  
  METHODS
  A case report of a 52-year-old white woman who received conventional therapy for urticaria for 3 years, with no improvement. Following this period, a diagnosis of AOSD was performed based on the presence of systemic symptoms.
  
  
  RESULTS
  The inflammatory activity markers decreased by the second month of methotrexate therapy; however, the cutaneous lesions failed to disappear. Thalidomide was initiated, and total improvement of the cutaneous lesions was observed after 2 weeks.
  
  
  CONCLUSIONS
  Urticarial rash is an uncommon presentation of AOSD, and clinicians must be alert to the possibility of a misdiagnosis in these cases.
authors.affiliation: Allergy Unit, Dermatology Department of Faculdade de Medicina do ABC, Santo André, Brazil.
authors.forename: Roberta F J
authors.initials: RF
authors.lastname: Criado
authors.forename: Paulo Ricardo
authors.initials: PR
authors.lastname: Criado
authors.forename: Cidia
authors.initials: C
authors.lastname: Vasconcellos
authors.forename: José Carlos M
authors.initials: JC
authors.lastname: Szajubok
authors.forename: Nilceo S
authors.initials: NS
authors.lastname: Michalany
authors.forename: Bogdana Victoria
authors.initials: BV
authors.lastname: Kadunc
authors.forename: Jose Eduardo
authors.initials: JE
authors.lastname: Costa Martins
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D016706:Still's Disease, Adult-Onset / Q000150:complications / Q000175:diagnosis*; D014581:Urticaria / Q000175:diagnosis* / Q000209:etiology