Adult Onset Still's Disease with Initial Manifestations Mimicking Pneumonia with Pleural Effusion-A Case Report

成人史迪爾氏症以肺炎和肋膜積液來表現－一病例報告

陳長宏(Chang-Hung Chen) ； 葉宏明(Horng-Ming Yeh)

《胸腔醫學》 24卷2期 (2009/04) Pp. 106-110

https://doi.org/10.29806/TM.200904.0005

摘要

成人史迪爾氏症是少見的全身性發炎性疾病，致病的原因不明，主要以高燒、紅疹、關節炎和多重器官症狀來表現。華人的成人史迪爾氏症個案以肺炎和肋膜積液為初期表現的較少。本病例為一49歲女性病患，因發燒和咳嗽而來就診。胸部X光發現右下肺葉浸潤增加，兩側有肋膜積液。因此在社區性肺炎的臆測下給予抗生素治療，但仍持續發燒，並有心包膜積液和關節疼痛等現象。實驗數據顯示白血球高達38841/ul，C反應性蛋白高達28.17 mg/dl，ferritin高達4184 ng/ml，經類固醇治療後發燒、咳嗽及關節痛等症狀解除，肋膜積液也消除。我們認為，以肺炎和肋膜積液來表現的成人史迪爾氏症相當少見，內科醫師應當注意相關的診斷要件，以求早日發現病因。

關鍵字

成人史迪爾氏症 ； 肺炎 ； 肋膜積液 ； C-反應蛋白

並列摘要

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology characterized by spiking fevers with an evanescent rash, arthritis, and multi-organ dysfunction. Pneumonia with pleural effusion are uncommon presentation among ethnic Chinese patients. Herein, we examine the case of a 49-year-old female patient admitted to our hospital complaining of incessant coughing and spiking fever. Chest radiograph showed pulmonary infiltrates in bilateral lung fields. Cardiac echography showed minimal pericardial effusion. Right wrist and left shoulder arthralgia were also noted. Fever persisted despite the administration of antibiotics. Laboratory data revealed leukocytosis, high C-reactive protein (CRP), and ferritin. The fever, cough, pleural effusion and arthralgia subsided promptly after steroid treatment. Patient follow-up at our outpatient clinic confirmed clinical remission. We advise clinicians to be aware of this particular symptomological presentation and to look for suggestive clinical symptoms, so as to achieve a more rapid and accurate diagnosis.

並列關鍵字

Adult-onset Still's disease AOSD ； pneumonia ； pleural effusion ； CRP C-reactive protein