Fever, Rash, and Swelling: Don't Miss This Diagnosis

Stephen Paget, MD


January 04, 2011

Hospitalization and Diagnosis

The patient was hospitalized for 3 days for assessment of her illness. All cultures were negative, and computed tomography of the chest, abdomen, and pelvis were normal. Results of antinuclear antibody, ANCA, rheumatoid factor, and anti-cyclic citrullinated peptide tests were also negative. After consideration of the preceding differential diagnosis, adult-onset Still's disease was diagnosed. Still's disease is a systemic, inflammatory disorder that occurs in children (in whom it is called both "Still's disease" and "systemic-onset juvenile idiopathic arthritis") and adults (in whom it is designated as "adult-onset Still's disease"). In both children and adults the clinical picture includes arthritis, fever, fatigue, rash, leukocytosis, adenopathy, and hepatosplenomegaly. On the basis of this diagnosis, the patient began receiving prednisone, 20 mg twice daily; joint inflammation, fatigue, fever, anemia, leukocytosis, and thrombocytosis rapidly improved.


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