[Adult Still's disease. A great simulator. Retrospective review of 20 patients].
BACKGROUND
Adult Still's disease is an inflammatory disorder characterized by quotidian fevers, and an evanescent rash. Its presentation can be acute or subacute.


OBJECTIVE
To report our experience with Adult Still's disease.


METHODS
Systematic retrospective review of medical records of nine men and 11 women aged between 17 and 57 years, with Still's disease, followed in two public hospitals of Metropolitan Santiago.


RESULTS
Eighty percent of patients had a prior different diagnosis. All presented with fever and joint involvement. Eighty percent had malaise, 80% had odynophagia, 80% had an evanescent rash, 70% had myalgias, 50% had lymph node enlargement and 40% had splenomegaly. Laboratory showed leukocytosis in 80% and a high erythrocyte sedimentation rate in all. High ferritin levels were detected in 80%, and became an important diagnosis clue. Initial treatment was based on non steroidal antiinflammatory drugs, however 80% required steroids and 35% required methotrexate. Azathioprine, sulphalazine, hydroxychloroquine and leflunomide were used occasionally. Eleven patients had a single episode, nine had a relapsing disease and four had a chronic or persistent mode.


CONCLUSIONS
Adult Still's disease must be suspected in patients with fever of unknown origin. An early diagnosis and adequate treatment of the disease are associated with a favorable evolution and prognosis.
Carreño
M Angela
MA
Servicio de Medicina, Unidad de Reumatología, Hospital San Juan de Dios, Chile.
Carvallo
Aurelio
A
Trejo
Cecilia
C
Ballestero
Francisco
F
Martínez
Carola
C
D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D005260:Female; D005293:Ferritins / Q000097:blood; D005335:Fever of Unknown Origin / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016706:Still's Disease, Adult-Onset / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D005293:Ferritins