Analysis Of Misdiagnosis Of Adult-onset Still's Disease

Objective: To investigate the clinical features,differential diagnosis and misdiagnosis analysis of adult-onset still's disease.Methods: To analyze the clinical data of one case of AOSD patients,through the review of related literature,analyse the causes of misdiagnosis,summarise the diagnosis and treatment experience of fever of unknown origin.History: A 19-year-old male patient,with fever without induction for more than 20 days before be admitted to hospital,the body temperature up to 41?,with chills,Shiver,sore throat,weakness,then given anti-infection treatment for 7 days in the local hospital,there was no improvement.Three days before be admitted to hospital,the rash appeared in the chest and limbs accompanied by fever,sense the pain of right chest,then visit in the local people's hospital,check blood routine:WBC 18.47 * 109 /L,N 86.60%;ESR 77mm/h;PCT 0.56ng/ml;CRP 76.90mg/L;Urine routine : occult blood +,white blood cell count: 11 /UL;laryngoscopy: acute pharynx laryngitis;diagnosed as: acute pharyngitis,given "ceftizoxime sodium" anti-infection treatment for3 days,there was no improvement,the patients and families for further diagnosis and treatment,then come to the clinic of our hospital,be admitted as fever of unknown origin.Previously,there was a history of “chronic appendicitis”,and 3 days before be admission to hospital,in the process of infuse the“levofloxacin”,the patient suffered from systemic rash,itching obvious,the discomfort above relieved after drug withdrawal.1 months ago,the patients went to Xinjiang,there is no history of direct contact with non-toxic,chemicals,water,cattle and sheep,no history of mosquito bites.Examination: pharyngeal congestion,no exception.Intervention and outcome : Combining with the history and related tests and examinations,the initial diagnosis of fever of unknown origin,Acute upper respiratory tract infection ? Given "XiYanping" and "moxifloxacin" anti-inflammatory,anti-infection treatment,in the process of infuse the“Xi Yanping”,the patient suffered from fever,systemic rash,itching obvious,the discomfort above relieved after drug withdrawal and the rash subsided after antiallergic therapy.Considering the patient use the antibiotics outside the hospital for more than 10 days,and in the process of infuse "levofloxacin" outside also occurred the situations of rash,so the causes of fever can not exclude drug fever,and can not rule out the rash is caused by drug allergy,so given no antibiotics,the patient still have a fever,the temperature fluctuation at38.3-39.4?,the red rash Scattered in the chest and limbs accompanied by fever,Combined with his CT scan of Chest and abdomen,the causes of fever can not exclude abdominal infection,given“ceftizoxime and tinidazole ”anti-infection treatment,the patients still have a fever,the temperature fluctuation at 36.8-39.7 ?,fever with chills,and pains of bilateral elbow and wrist,plus "naproxen" control the pain and "Tamiflu" antiviral treatment,there was no improvement.Then replaced with the "teicoplanin + tinidazole" anti-infection treatment,still have a fever.The culture of alveolar lavage fluid indicated that Pseudomonas aeruginosa infection,changed to "imipenem" anti-infection,still have a fever,and the serological examination without prompt for the diagnosis of disease.Patient with intermittent fever for T?39 ?continued more than 1 month,the rash appeared accompanied by fever and subsided as the temperature returned to normal,checked blood routine repeatedly indicated that WBC ? 10 × 109 / L,N ? 80%,with sore throat,transient joint pain,abnormal liver function,RF and ANA are negative,elevated serum ferritin level,the treatment of multiple antibiotics is invalid,the serological examination without prompt for the diagnosis of disease.Refer to the Yamaguchi standard on diagnosis of AOSD,the patient diagnosed AOSD was established,antibiotics were stopped,received prednisone 25 mg 2/day orally for 3 days,the temperature dropped to normal.Conclusion: AOSD is a rare systemic inflammatory disease,the exact pathogenesis is unclear,there are 5%-10% patients showed fever accompanied by systemic inflammatory response,no specific organ involvement,three typical features of AOSD are: persistent high fever,arthralgia,rash,the diagnosis of AOSD is usually exclusionary,has not yet found a pathological diagnosis test and reliable biological indicators,the application of glycosylated ferritin to improve the specificity of diagnosis,definite diagnosis should be based on Yamaguchi and Fautre diagnostic criteria,to exclude infectious diseases,malignant tumors and other related connective tissue diseases.the serological examination of our patient without prompt for the diagnosis of disease,but can be used to identify and exclude other fever-related diseases.The lack of specific serological or clinical markers for disease diagnosis,is the causes of the delayed diagnosis and the deterioration of complications.so pay attention to the specific clinical manifestations in the disease process,when multiple antibiotics therapy is invalid,should take into account AOSD,so as not to delay diagnosis and treatment.