Department of Ophthalmology, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha 410008, China.
Rheumatol Int. 2013 Jul;33(7):1867-72. doi: 10.1007/s00296-011-2351-7. Epub 2011 Dec 31.
Adult-onset Still's disease (AOSD) is a rare and systemic inflammatory disorder of unknown etiology and pathogenesis. AOSD is characterized by high fever accompanied by a range of systemic symptoms. However, there are rare cases of AOSD with ophthalmologic symptoms as well as with an obvious causation of corticosteroid withdrawal. In this case, a 43-year-old male patient diagnosed with AOSD showed ocular inflammation after withdrawing from corticosteroid treatment. This patient was treated with prednisolone for AOSD and discharged after achieving complete remission of breathlessness, backache, thoracalgia, joint pain, and spiking fever. The patient unauthorizedly stopped taking prednisolone after he was discharged from the hospital and returned to the Department of Ophthalmology with the complaint of decreased visual acuity in both eyes for half a month and sudden vision loss in the left eye for 3 days. After regular ophthalmologic examinations and fluorescence angiography examination, he was diagnosed with acute panuveitis as the manifestation of AOSD. Uveitis was effectively treated with corticosteroid drugs. This case reported a rare manifestation of AOSD in an ophthalmological system that was associated with the withdrawal of corticosteroid treatment. This report highlighted the therapeutic effect of local and systemic corticosteroid use for AOSD manifested with uveitis. This case is interesting for both rheumatologists and ophthalmologists.
成人Still 病(AOSD)是一种罕见的、病因和发病机制不明的全身性炎症性疾病。AOSD 的特征是高热伴有一系列全身症状。然而,也有少数 AOSD 患者伴有眼部症状,且明显与皮质类固醇停药有关。在本例中,一名 43 岁男性患者在停用皮质类固醇治疗后出现眼部炎症,该患者因 AOSD 接受泼尼松龙治疗,呼吸困难、背痛、胸痛、关节痛和高热完全缓解后出院。该患者出院后擅自停用泼尼松龙,并因双眼视力下降半个月,左眼视力突然丧失 3 天返回眼科就诊。经过常规眼科检查和荧光血管造影检查,诊断为 AOSD 的表现之一——急性全葡萄膜炎。葡萄膜炎经皮质类固醇药物治疗有效。本病例报告了一种罕见的以皮质类固醇治疗停药为诱因的 AOSD 眼部系统表现。该报告强调了局部和全身皮质类固醇治疗 AOSD 伴发葡萄膜炎的疗效。该病例对风湿病学家和眼科医生都有一定的参考价值。