Pak Stella, Pham Cindy
Internal Medicine, University of Toledo Medical Center.
Cureus. 2017 Jun 7;9(6):e1321. doi: 10.7759/cureus.1321.
Adult-onset Still's disease (AOSD) is a systemic autoinflammatory disease characterized by symptoms including spiking fever, arthralgia, myalgia, maculopapular rash, and pharyngitis. The lack of diagnostic biomarker, non-specific clinical presentation, and the rarity of AOSD often result in a significant delay in diagnosis and treatment. While the average time of initial presentation to diagnosis is four months, we present a case of AOSD diagnosis three years after initial onset of classical symptoms. By reporting the case of delayed diagnosis for AOSD, we hope to raise awareness in our medical community about the diagnostic difficulty in AOSD. The present case describes an otherwise healthy male who presented with typical symptoms of AOSD, but the diagnosis of AOSD was missed during his first presentation. In the second flaring episode, the diagnosis of AOSD was established. He had an excellent therapeutic response to anakinra and prednisone during the acute flaring episode. He is currently in complete remission on methotrexate as maintenance therapy.
成人斯蒂尔病（AOSD）是一种系统性自身炎症性疾病，其特征症状包括高热、关节痛、肌痛、斑丘疹和咽炎。缺乏诊断生物标志物、临床表现不具特异性以及AOSD的罕见性常常导致诊断和治疗的显著延迟。虽然从初次出现症状到诊断的平均时间为四个月，但我们报告了一例在典型症状初次发作三年后才诊断为AOSD的病例。通过报告AOSD延迟诊断的病例，我们希望提高医学界对AOSD诊断困难的认识。本病例描述了一名原本健康的男性，他出现了AOSD的典型症状，但在首次就诊时漏诊了AOSD。在第二次病情发作时，确诊为AOSD。在急性发作期，他对阿那白滞素和泼尼松有良好的治疗反应。他目前在接受甲氨蝶呤维持治疗，处于完全缓解状态。
