10/19/16 Resident Morning Report – FUO and Adult Onset Still’s Disease

CC: 6 days of fevers and URI symptoms

ID: 67 yo female with pernicious anemia presents with 6 days of fevers and URI symptoms and 3 weeks of nonpruritic, round, scaly rash on her forearm. Exam was notable for a temperature of 39.4C, anterior cervical lymphadenopathy, shotty inguinal lymphadenopathy, and an absence of a rash initially. After a week of inpatient evaluation, patient continued to have fevers, and was noted to have a faint, erythematous rash on her chest, back, and arms. Further studies revealed a ferritin of > 8000; patient was eventually diagnosed with adult Still’s Disease.

harrisons-fuo-algorithm

Approach to FUO Algorithm


Pearls from morning report:

  • In a patient who is >55 y.o with elevated ESR and persistent fevers, consider temporal artery biopsy.
  • Patients with adult Still’s Disease usually have fevers that spike in the afternoon or two spiking fevers in one day (“double-quotidian”).

Random trivia:

Still’s Disease was named after Sir George Frederic Still, an English pediatrician who first described juvenile rheumatoid arthritis (JRA).  The syndrome gets its name from its resemblance to the systemic form of JRA and was first described in adults by British physician, Eric Bywaters.

Also, congratulations to Mario Ho for submitting a new record high. She took care of a patient with a ferritin of 45,874 ng/mL!


Want to read more?

Fever of Unknown Origin: A Clinical Approach (The American Journal of Medicine)


References: 

Bleeker-Rovers CP, van der Meer JM. Fever of Unknown Origin. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2015. http://accessmedicine.mhmedical.com/content.aspx?bookid=1130&Sectionid=79724594. Accessed October 19, 2016.

 

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