Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
Semin Arthritis Rheum. 2011 Feb;40(4):324-9. doi: 10.1016/j.semarthrit.2010.03.004. Epub 2010 Jun 11.
A 27-year-old woman was hospitalized with fever and visual changes. She had been well until nine months earlier when she developed unilateral blurry vision in the left eye. Ophthalmologic examination revealed bilateral acute anterior uveitis. She was treated with topical steroids and her vision returned to baseline. However, over the next few months, she developed debilitating fatigue and experienced an unintentional fifteen pound weight loss. One month prior to presentation, she noted the onset of daily low grade fevers and chills. On the day of admission, she developed a temperature of 103°F and a severe frontal headache. Here we describe a case where the overlap of clinical features led to an initially broad differential diagnosis of seemingly unrelated diseases. Ultimately, the discovery of a key radiographic finding allowed us to more clearly define the diagnosis.
一位 27 岁女性因发热和视力改变而住院。她之前身体状况良好,直到九个月前左眼出现单侧视力模糊。眼科检查发现双侧急性前葡萄膜炎。她接受了局部类固醇治疗,视力恢复到基线水平。然而,在接下来的几个月里,她出现了使人虚弱的疲劳感,并意外地减轻了 15 磅体重。在就诊前一个月,她开始每天出现低度发热和寒战。入院当天,她的体温达到 103°F,并出现严重的额头痛。在这里,我们描述了一个病例,其中临床特征的重叠导致了最初广泛的鉴别诊断,涉及看似无关的疾病。最终,关键影像学发现的发现使我们能够更清楚地定义诊断。