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Abstract
Adult-onset Still's disease (AOSD) is an inflammatory dis-order of unknown aetiology characterized by a variety of clinical symptoms. AOSD can precede or occur con-comitantly with AS and only a few cases of AOSD with AS have been reported. A 21-year-old man presented with spiking fever, sore throat, arthralgia, maculopapular rash, lym-phadenopathy, and chronic inflammatory back pain. His laboratory findings showed marked elevations of liver enzyme, C-reactive protein, erythrocyte sedimentatioin rate, ferritin, and sacroiliitis (grade 2), which were the main characteristics of AOSD and AS. Most symptoms except chronic low back pain were improved after treatment with corticosteroid and disease modifying antirheumatic drugs. He was then treated with antitumor necrosis factor-alpha (anti-TNF-α) agents to control the disease activity of AS and subsequently showed clinical and serological improvement. This is a first case report of AOSD combined with AS in Korea.
References
1. Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore). 1961; 40:1–30.
2. Zenone T. Fever of unknown origin in rheumatic diseases. Infect Dis Clin North Am. 2007; 21:1115–35.
3. Mert A, Ozaras R, Tabak F, Bilir M, Ozturk R, Ozdogan H, et al. Fever of unknown origin: a review of 20 patients with adult-onset Still's disease. Clin Rheumatol. 2003; 22:89–93.
4. Pouchot J, Sampalis JS, Beaudet F, Carette S, Décary F, Salusinsky-Sternbach M, et al. Adult Still's disease: manifestations, disease course, and outcome in 62 patients. Medicine (Baltimore). 1991; 70:118–36.
5. Crispín JC, Martí nez-Baños D, Alcocer-Varela J. Adu-lt-onset Still disease as the cause of fever of unknown origin. Medicine (Baltimore). 2005; 84:331–7.
6. Fautrel B, Le Moël G, Saint-Marcoux B, Taupin P, Vignes S, Rozenberg S, et al. Diagnostic value of ferritin and glycosylated ferritin in adult onset Still's disease. J Rheumatol. 2001; 28:322–9.
7. Bagnari V, Colina M, Ciancio G, Govoni M, Trotta F. Adult-onset Still's disease. Rheumatol Int. 2010; 30:855–62.
8. Bywaters EG. Still's disease in the adult. Ann Rheum Dis. 1971; 30:121–33.
9. Carter ME. Sacro-ilitis in Still's disease. Ann Rheum Dis. 1962; 21:105–20.
11. Akkoc N, Sari I, Birlik M, Pay S, Binicier O, Akar S, et al. Ankylosing spondylitis and spondylarthropathy presenting with a clinical picture of adult onset Still's disease: case series. Rheumatology (Oxford). 2008; 47:1436–7.
12. Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007; 369:1379–90.
13. Arlet JB, Gentelle S, Grasland A, Pouchot J, Vinceneux P. Febrile form of ankylosing spondylitis. Rev Med Interne. 2002; 23:81–4.
14. del Amo López R, Burgos Díez C, Reina Gallego C. High temperature and ankylosing spondylitis. Aten Pri-maria. 2004; 33:53.
15. Mathur T, Manadan AM, Hota B, Block JA. Pseu-do-septic hip arthritis as the presenting symptom of ankylosing spondylitis: a case series and review of the literature. Clin Exp Rheumatol. 2010; 28:416–8.
Figure 2.
(A) Anteroposterior radiograph of the pelvis shows the erosive change and subchondral sclerosis of the bilateral sacroiliac (SI) joints, which is compatible with bilateral sacroiliitis, grade 2. (B) The sacrum CT revealed irregularity of the articular surface of the left SI joint with possible erosions and pseudo-widening of the right SI joint space, and all this is compatible with sacroiliitis.
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