Few clues to diagnosis

doi:10.1136/bmj.38978.380000.68

BMJ 2006;333:692-693 (30 September), doi:10.1136/bmj.38978.380000.68

Commentary

Few clues to diagnosis

Paul Emery, head¹, Jane Freeston, specialist registrar in rheumatology¹

¹ Academic Section of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds LS7 4SA

Correspondence to: P Emery p.emery@leeds.ac.uk

The first 150 words of the full text of this article appear below.

Adult onset Still's disease is a difficult clinical diagnosis.There are few, if any, diagnostic features, with the possibleexception of a very high ferritin concentration. Sivakumar andcolleagues describe a not atypical case history of a patientpresenting with fever.¹ Not unnaturally, the patient was assumedto have an infection. This is understandable and correct, asmissing infection could clearly have had serious consequences.For every patient with adult onset Still's disease there area significant number of patients with severe infection, andit is crucial that infection is the first diagnosis to be excluded.

The persistence of the fever after treatment was the first cluethat the patient may have something other than infection. Developmentof a rash was perhaps the first concrete clue to her diagnosis.Her raised ferritin concentration was highly suggestive, althoughvery high concentrations are more specific. The problem withthe Yamaguchi diagnostic criteria . . . [Full text of this article]