成人Still病被误诊为肺部感染1例报告并文献复习  

Adult-Onset Still’s Disease Misdiagnosed as Pulmonary Infection:a Case Report and Literature Review

作　　者：周临娜 张峻[1] 相萍萍 徐方 陈堃[2] 杨建巧[1] ZHOU Lin-na;ZHANG Jun;XIANG Ping-ping;XU Fang;CHEN Kun;YANG Jian-qiao(Department of Cardiology,Hangzhou Xiacheng District Hospital of Integrated Traditional Chinese and Western Medicine,Hangzhou 310000,China;Department of Endocrinology,Jiangsu Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing 210028,China)

机构地区：[1]杭州市下城区中西医结合医院心内科,杭州310000 [2]江苏省中西医结合医院内分泌科,南京210028

出　　处：《实用临床医学（江西）》2021年第2期1-4,58,共5页Practical Clinical Medicine

基　　金：国家自然科学基金项目(81904149)。

摘　　要：目的为临床医生提供成人Still病(AOSD)案例依据及诊治思路。方法回顾性分析1例以不明原因发热为首发表现的、临床症状不典型的AOSD病例的临床资料,并进行相关文献复习。结果患者,男,65岁,反复发热一月余;发热1个月后出现皮疹,最高体温39.9℃;病程中患者白细胞(WBC)和中性粒细胞(NEU)持续升高,血清铁蛋白(SF)3597.45μg·L-1,肝功能、抗核抗体、肿瘤标志物正常,血培养、骨髓培养、肥达氏试验、真菌检查、结核杆菌抗体、传染病三项、大便隐血、三线培养均阴性。通过病例资料分析及文献比对,最终确诊为AOSD。抗生素治疗效果欠佳,后经强的松片治疗后患者病情平稳,无发热,皮疹消退。结论AOSD临床比较罕见,没有统一的诊断标准及专家共识,作为一种排他性诊断,临床容易误诊,延误治疗,及时诊治是影响预后的关键。Objective To provide case basis and ideas for the diagnosis and treatment of adult-onset Still’s disease(AOSD).Methods The clinical data of a case of AOSD with unexplained fever as the initial presentation and atypical symptom were analyzed retrospectively.In addition,the related literature was reviewed.Results The 65-year-old patient had a rash after a month of fever,with a maximum body temperature at 39.9℃.In this patient,white blood cells and neutrophils continuously increased,but serum ferritin(3597.45μg·L-1),liver function,antinuclear antibody and tumor markers were normal throughout the course of the disease.Furthermore,the results of blood culture,bone marrow culture,Widal test,fungal examination,Mycobacterium tuberculosis-specific antibody detection,three tests for infectious diseases,fecal occult blood screening and third-line culture were negative.AOSD was finally confirmed by case analysis and literature comparison.The patient did not respond well to antibiotics.After treatment with prednisone tablets,the patient’s condition was stable and the fever and rash subsided.Conclusion AOSD is a rare systemic disease that is a diagnosis of exclusion and lacks unified diagnostic criteria and expert consensus.AOSD is prone to misdiagnosis to delay treatment.Therefore,timely diagnosis and treatment are the key to the prognosis.

关 键 词：成人STILL病 肺部感染 误诊 自身免疫性疾病 病例报告 

分 类 号：R593.2[医药卫生—内科学]