Mollaeian Arash, Chen Jingjing, Chan Nina N, Nizialek Gregory A, Haas Christopher J
MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA.
Georgetown University School of Medicine, Washington, DC, USA.
BMC Rheumatol. 2021 Apr 20;5(1):12. doi: 10.1186/s41927-021-00183-6.
Adult onset Still's disease (AOSD) is a rare inflammatory disorder that classically presents with high spiking fevers, evanescent rash, and arthritis. The diagnosis is one of exclusion and can be further complicated by atypical presentations, particularly in elderly patients in whom AOSD is very rare.
A case of AOSD in a 73-year-old woman with a non-classic presentation, leading to delayed diagnosis and management, is presented along with a review of the English literature for AOSD cases in elderly people over 70 years of age. Thirty nine case reports and series were identified and the current case was added, totaling 42 individual cases. Significant findings included a four-times higher prevalence in females, a higher prevalence of macrophage activation syndrome despite lower mortality, the presence of pruritic rash in almost one fifth of the cases, and high prevalence of delayed diagnosis.
AOSD in the elderly may vary from the classic criteria described in the medical literature and may lead to delayed diagnosis and management. Further evaluation and better characterization of AOSD in the elderly remains an area of interest.
成人斯蒂尔病（AOSD）是一种罕见的炎症性疾病，典型表现为高热、一过性皮疹和关节炎。该疾病的诊断是排除性诊断，非典型表现会使其诊断更加复杂，尤其是在AOSD非常罕见的老年患者中。
本文报告了一例73岁女性的AOSD病例，其临床表现不典型，导致诊断和治疗延迟，并回顾了英文文献中70岁以上老年人AOSD病例。共识别出39篇病例报告和系列病例，并纳入本病例，总计42例个体病例。重要发现包括女性患病率高出四倍、尽管死亡率较低但巨噬细胞活化综合征患病率较高、近五分之一的病例出现瘙痒性皮疹以及诊断延迟的高患病率。
老年人的AOSD可能与医学文献中描述的经典标准不同，可能导致诊断和治疗延迟。对老年人AOSD的进一步评估和更好的特征描述仍是一个研究热点。
