Few clues to diagnosis

BMJ 2006; 333 doi: (Published 28 September 2006) Cite this as: BMJ 2006;333:692
  1. Paul Emery, head (,
  2. Jane Freeston, specialist registrar in rheumatology1
  1. 1 Academic Section of Musculoskeletal Disease, Chapel Allerton Hospital, Leeds LS7 4SA
  1. Correspondence to: P Emery

    Adult onset Still's disease is a difficult clinical diagnosis. There are few, if any, diagnostic features, with the possible exception of a very high ferritin concentration. Sivakumar and colleagues describe a not atypical case history of a patient presenting with fever.1 Not unnaturally, the patient was assumed to have an infection. This is understandable and correct, as missing infection could clearly have had serious consequences. For every patient with adult onset Still's disease there are a significant number of patients with severe infection, and it is crucial that infection is the first diagnosis to be …

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