Analysis of Misdiagnosis Causes in 26 Adult Patients with Still Disease
SUN Hong-liang
XIE Wen-xiu
MA Hang-hang
ZHAI Xin
HU Rui-lan
Abstract：Objective To analyze clinical characteristics of adult onset still's disease (AOSD) and explore misdiag-nosis causes in order to improve the accuracy of diagnosis. Methods We retrospectively analyzed 26 misdiagnosed cases with AOSD, admitted to our hospital during January 2001 and September 2013. Results 26 out of 46 patients were misdiagnosed and the misdiagnosis rate was 56. 5% . All the misdiagnosed cases had a fever. Rash appeared in 22 cases and joint pain or arthritis in 19 cases. 8 cases were misdiagnosed as sepsis. 5 cases were misdiagnosed as drug eruption. 3 cases were misdiag-nosed as pneumonia. 3 cases were misdiagnosed as rheumatic fever. 2 were misdiagnosed as typhoid. 2 cases were misdiag-nosed as rheumatoid arthritis. 1 case was misdiagnosed as lymphoma. 1 case was misdiagnosed as leukemia reaction. 1 case was misdiagnosed as tuberculosis. Serum ferritin increased in 24 patients. The percentage of glycosylated ferritin was signifi-cantly decreased ( < 20% ) in 16 cases. White blood cells increased in 23 cases and thrombocytosis in 11 cases. Erythrocyte sedimentation rate was higher in 24 cases and C-reactive protein was elevated in 18 patients. All the cases met the Yamaguchi criteria published in Japan in 1992 by the AOSD research committee. After a definitive diagnosis, the treatment was undertak-en with application of nonsteroidal anti-inflammatory drugs combined with corticosteroids or immunosuppressants according to the condition of the cases. 18 patients were completely relieved. 5 cases relapsed after one year and 3 cases relapsed after two years. Conclusion The clinical manifestation of AOSD is complex and changeable, and it tends to be misdiagnosed. Clini-cians should be fully aware of response to AOSD. Detection of glycosylated ferritin is specific for diagnosis of AOSD, which is helpful in the differential diagnosis of AOSD.
Keywords：Still diseaseadult onsetMisdiagnosisSepsisDrug eruptionPneumonia
Publication Date：2015-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：3( 25-27 )