成人Still氏症以不明原因發燒來表現

Adult Onset Still's Disease Presenting with Fever of Unknown Origin

成人Still氏症是一種少見的全身性發炎性疾病，原因不明，特色是發燒伴隨有發疹，關節炎併發多器官表現。成人Still氏症常是不明原因發燒的可能原因之一。ㄧ位23歲男性病人因為持續發燒四周而到本院求診，經急診入院，體溫會高達攝氏39度以上並在一天之內降回正常。住院時懷疑為感染性心內膜炎，但心臟超音波及血液培養結果皆為陰性，也沒有新的不明原因的心雜音出現。住院期間發現病患在發燒時合併有出疹現象，且這個病患同時有左膝和右肩關節痛。因為發燒關節痛和出疹等現象，而懷疑是成人Still氏症。經過類固醇和其他免疫抑制劑治療後體溫迅速回復正常，其他臨床症狀改善和白血球和血清鐵素等數值也都下降，此病人繼續在門診追蹤。

Adult onset Still’s disease is a rare systemic inflammatory disorder of unknown etiology, characterized by spiking fevers with an evanescent rash, arthritis, and multiple organ involvement. Adult onset Still’s disease is also one of the most frequent etiologies of fever of unknown origins (FUO). This 23-year-old male patient presented to our hospital with a chief complaint of daily fevers off and on for 4 weeks. A rash over his legs and arms developed, especially during the fever. Also, left knee and right shoulder joint pain was noted. Infective endocarditis was ruled out by negative echocardiography, negative blood culture result and no new onset murmur. Due to the quotitian fever with rash and arthralgia, adult onset Still’ disease was diagnosed. After prednisolone and other immunosuppressive agents were given, the fever and arthralgia subsided promptly. Clinical resolution was achieved and laboratory markers (such as the ferritin and leucocyte count) dropped. He was followed up at the outpatient clinic with clinical remission.