Enfermedad de Still del adulto: Una gran simuladora. Experiencia clínica basada en 20 casos

• M Ángela Carreño ^[1] ; Aurelio Carvallo ^[1] ; Cecilia Trejo ^[1] ; Francisco Ballestero ^[2] ; Carola Martínez ^[2]
  1. [1] Hospital San Juan de Dios

     Hospital San Juan de Dios

     Santiago, Chile

     
  2. [2] Hospital San Borja Arriarán Unidad de Reumatología Servicio de Medicina
• Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 137, Nº. 8, 2009, págs. 1010-1016
• Idioma: español
• Títulos paralelos:
  • Adult Still's disease: Retrospective review of 20 patients
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• Resumen

  • Background: Adult Still's disease is an inflammatory disorder characterized by quotidian fevers, and an evanescent rash. Its presentation can be acute or subacute. Aim: To report our experience with Adult Still's disease. Material and methods: Systematic retrospective review of medical records of nine men and 11 women aged between 17 and 57 years, with Still's disease, followed in two public hospitals of Metropolitan Santiago. Results: Eighty percent of patients had a prior different diagnosis. All presented with fever and joint involvement. Eighty percent had malaise, 80% had odynophagia, 80% had an evanescent rash, 70% had myalgias, 50% had lymph node enlargement and 40% had splenomegaly. Laboratory showed ¡eukocytosis in 80% and a high erythrocyte sedimentation rate in all. High ferritin levels were detected in 80%, and became an important diagnosis clue. Initial treatment was based on non steroidal antiinflammatory drugs, however 80% required steroids and 35% required methotrexate. Azathioprine, sulphalazine, hydroxychloroquine and ¡eflunomide were used occasionally. Eleven patients had a single episode, nine had a relapsing disease and four had a chronic or persistent mode. Conclusions: Adult Still's disease must be suspected in patients with fever of unknown origin. An early diagnosis and adequate treatment of the disease are associated with a favorable evolution and prognosis.