ADULT ONSET STILL’S DISEASE-A DIAGNOSIS OF EXCLUSION
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 15
Abstract
PRESENTATION OF CASE A 27-year-old lady, married came with chief complaints of fever since 1-month duration and pain in both knee joints, since 20 days. Fever was high grade, 2-3 spikes /day, not associated with chills or rigor. Right knee joint pain followed with left knee, not associated with swelling or any skin discolouration. Patient was worked up extensively for 3 weeks with investigations ranging from complete blood count, Fever profile including– malaria, leptospirosis, dengue, blood culture, Urine routine and culture, Blood for fungal culture, ANA, RA factor, anti- CCP antibody, p- ANCA, c- ANCA, Quantiferon Gold TB test, Bone marrow aspirate and biopsy, IgM for Brucella, IgM for chikungunya, EBV, HIV, HBsAg, HCV, CT brain and CT abdomen which were all negative. Significant investigations were –CBC s/o Leucocytosis and Raised neutrophils count, ESR was raised (110 mm per hour), Ferritin was raised (???), USG abdomen and pelvis reveal mild hepatosplenomegaly, 2D Echo s/o minimal pericardial effusion, CT-Thorax s/o bilateral minimal pleural effusion, Whole body PET scan – s/o bilateral minimal pleural effusion. Patient had received – Antimalarials and antibiotics like Ceftriaxone (for 5 days), Piperacillin+Tazobactum (for 7 days), Meropenem (for 11 days), but still fever persisted even after 4 weeks in a private hospital and hence patient was referred to our Sir J.J.Groups of hospital, Mumbai for further management. 27-year-old married female with symptoms of fever, arthralgia, and intermittent rash of 1-month duration; On Examination the patient was well built, conscious and oriented, patient was febrile 103°F, heart rate of 98b/min, blood pressure of 110/70 mmHg, with Effervescent reddish macular rash over both hands, and normal jugular venous pressure, with no pallor / lymphadenopathy. Mild Hepatosplenomegaly was present, and investigations showing leucocytosis with neutrophilia and raised ESR, Polyserositis, raised ferritin levels with negative ANA and RA-Factor. We diagnosed it as an Antibiotic induced fever / AOSD. We stopped antibiotics soon after the admission but still fever persisted even after 3-4 days. Patient was started on Prednisolone of 1 mg/kg BW and NSAIDS –Diclofenac sodium 50 mg bid. Patient became asymptomatic after 2 days and was discharged with advice of Tapering of steroids after 1 month of full course. Patient was asymptomatic when he came for regular check up
Authors and Affiliations
Tejasvi H. T
Keywords
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- EP ID EP555883
- DOI 10.18410/jebmh/2018/280
- Views 69
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