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Introduction
Adult onset Stills disease is a rare cause of pyrexia of
unknown origin in India. In various series adult onset Stills
disease is responsible for 5-9% patients of pyrexia of
unknown origin. Bywater first described this condition in
1971 with descriptions of 14 patients1 and since then small
series have been reported from India2-4. We report a series
of this multi-systemic inflammatory disorder which is
characterised by spiking fever, skin rash, arthralgia/
arthritis, and myalgia.
Observations
The male to female ratio was 5:3. The age varied from 18
to 65 years with mean age of 26.2 years. All patients
presented with high grade fever. All patients had taken
course of antibiotics (> 2). Four patients were on antitubercular therapy. Two patients were being treated as
cases of rheumatic fever.
* ImmnoRheumatology Clinic, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi-100 060.
87.5%
87.5%
100%
50%
100%
37.5%
25%
12.5%
0%
12.5%
Discussion
Adult onset Stills disease remains a difficult clinical
diagnosis, largely because of its rarity, protean
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October-December, 2004
Conclusions
Early diagnosis of adult onset Stills disease is possible if
treating physician is aware of the rare condition. Delay in
diagnosis is due to expensive investigations to exclude
occult infection or neoplasm. Value of hyperferritinaemia
Table III : Compares the important clinical parameters of adult onset Stills disease.
Features
Male : Female
Fever T > 39F
Rash
Arthralgia / Arthritis
Sore thorat
Lymphadenopathy
Splenomegaly
Hepatomegaly
Pleuritis / effusion
Uppal et al (1995)
N = 31
Bambery et al (1992)
N = 18
17:14
100%
36%
100%
39%
45%
58%
58%
7%
10:8
100%
50%
100%
67%
56%
56%
28%
Vol. 5, No. 4
October-December, 2004
329
5.
6.
References
1.
2.
3.
Flavedon AD
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Vol. 5, No. 4
October-December, 2004