Lämmle B, Steiger U, Schärer H, Schröder E, Thölen H
Schweiz Med Wochenschr. 1983 Jan 29;113(4):138-44.
Two patients with adult Still's disease are presented. Both had high "septic" fever, weight loss, mild pharyngitis, evanescent maculo-papular rash, myalgias, arthralgias, splenomegaly and pericarditis, while one of the two patients also had lymphadenopathy and pleurisy. Arthritis, which is a sine qua non for the diagnosis, developed only 5 months after disease onset in one patient. Both ultimately developed severe destructive joint disease requiring hip arthroplasty. Laboratory findings were neutrophilic leukocytosis, normochromic normocytic anemia, elevated ESR, slightly elevated liver enzyme values, negative IgM-rheumatoid factor and antinuclear antibodies, and normal or slightly elevated complement factors. Several biopsies failed to reveal pathognomonic findings. It is of the utmost importance that the exclusion diagnosis of adult Still's disease be posed in order to avoid repeated hospitalizations with undue investigations and unnecessary therapeutic trials with antibiotics.
本文报告了两名成人斯蒂尔病患者。两人均有高热“败血症样”发热、体重减轻、轻度咽炎、一过性斑丘疹、肌痛、关节痛、脾肿大和心包炎，其中一名患者还伴有淋巴结病和胸膜炎。关节炎是诊断的必要条件，其中一名患者在发病5个月后才出现关节炎。两人最终均发展为严重的破坏性关节疾病，需要进行髋关节置换术。实验室检查结果显示中性粒细胞增多、正细胞正色素性贫血、血沉升高、肝酶值轻度升高、IgM类风湿因子和抗核抗体阴性，补体因子正常或轻度升高。多次活检均未发现特征性表现。为避免因不必要的检查和抗生素治疗试验而反复住院，对成人斯蒂尔病进行排除诊断至关重要。
