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A Case of Adult Onset Still’s Disease Misdiagnosed as Septic Arthritis

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We present a case of adult onset Still’s disease (AOSD) that was misdiagnosed as septic arthritis of the shoulder and knee. A forty-nine-year-old woman was admitted for pain in the left knee. The patient’s medical history showed that she had undergone arthroscopic irrigation twice and an open debridement under the diagnosis of septic shoulder at another hospital. The laboratory and joint fluid analysis findings led us to suspect septic knee. Arthroscopic irrigation and antibiotics treatment were performed. At five weeks after discharge, she presented with pain in the same joint, fever, and rash. The symptoms were consistent with Yamaguchi’s criteria for AOSD. We started corticosteroid therapy, and clinical remission was achieved. In conclusion, we suggest that AOSD should be considered as a diagnosis of exclusion to avoid misdiagnosis with septic arthritis.

Abstract

We present a case of adult onset Still’s disease (AOSD) that was misdiagnosed as septic arthritis of the shoulder and knee. A forty-nine-year-old woman was admitted for pain in the left knee. The patient’s medical history showed that she had undergone arthroscopic irrigation twice and an open debridement under the diagnosis of septic shoulder at another hospital. The laboratory and joint fluid analysis findings led us to suspect septic knee. Arthroscopic irrigation and antibiotics treatment were performed. At five weeks after discharge, she presented with pain in the same joint, fever, and rash. The symptoms were consistent with Yamaguchi’s criteria for AOSD. We started corticosteroid therapy, and clinical remission was achieved. In conclusion, we suggest that AOSD should be considered as a diagnosis of exclusion to avoid misdiagnosis with septic arthritis.

참고문헌 (10)

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  6. Fautrel B, "Proposal for a new set of classification criteria of adult-onset still disease", Medicine, 81, pp.194~200 (2002)
  7. Crispin JC, "Adult-onset Still disease as the cause of fever of unknown origin", Medicine (Baltimore), 84, pp.331~337 (2005)
  8. Mehrpoor G, "Adult- onset Still’s disease: a report of 28 cases and review of the literature", Mod Rheumatol, 18, pp.480~485 (2008)
  9. Fautrel B, "Ferritin levels in adult Still’s disease: any sugar", Joint Bone Spine, 69, pp.355~357 (2002)
  10. Ames PR, "Multi-organ failure in adult onset Still’s disease: a septic disguise", Clin Rheumatol, 28(1), pp.S3~S6 (2009)

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