Adult-onset Still's disease physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Adult-onset Still’s disease}} | {{Adult-onset Still’s disease}} | ||
{{CMG}}; {{AE}} {{HK}} | |||
{{CMG}}; {{AE}} | |||
==Overview== | ==Overview== | ||
On [[physical examination]], a patient suffering from adult-onset Still's disease (AOSD) may appear fatigued, has a high grade [[fever]] (spiking [[fever]]), [[tachycardia]], salmon colored [[maculopapular rash]] on [[trunk]] and/or [[extremities]], [[lymphadenopathy]], [[hepatosplenomegaly]], [[Pleural effusion|pleural]] and [[pericardial friction rub]] (due to underlying [[pleuritis]] and [[pericarditis]]). | |||
==Physical Examination== | ==Physical Examination== | ||
On [[physical examination]], the following findings may be observed:<ref name="pmid1578458">{{cite journal |vauthors=Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H, Kashiwazaki S, Tanimoto K, Matsumoto Y, Ota T |title=Preliminary criteria for classification of adult Still's disease |journal=J. Rheumatol. |volume=19 |issue=3 |pages=424–30 |date=March 1992 |pmid=1578458 |doi= |url=}}</ref><ref name="pmid20303869">{{cite journal |vauthors=Kastner DL, Aksentijevich I, Goldbach-Mansky R |title=Autoinflammatory disease reloaded: a clinical perspective |journal=Cell |volume=140 |issue=6 |pages=784–90 |date=March 2010 |pmid=20303869 |pmc=3541025 |doi=10.1016/j.cell.2010.03.002 |url=}}</ref><ref name="pmid21576924">{{cite journal |vauthors=Oba Y, Abu-Salah T |title=The prevalence and diagnostic significance of eosinophilic pleural effusions: a meta-analysis and systematic review |journal=Respiration |volume=83 |issue=3 |pages=198–208 |date=2012 |pmid=21576924 |doi=10.1159/000327200 |url=}}</ref><ref name="pmid23424598">{{cite journal |vauthors=Antoniou KM, Margaritopoulos GA, Giannarakis I, Choulaki C, Fountoulakis N, Siafakas NM, Sidiropoulos P |title=Adult Onset Still's Disease: A Case Report with a Rare Clinical Manifestation and Pathophysiological Correlations |journal=Case Rep Med |volume=2013 |issue= |pages=981232 |date=2013 |pmid=23424598 |pmc=3568868 |doi=10.1155/2013/981232 |url=}}</ref> | |||
===Appearance of the patient=== | ===Appearance of the patient=== | ||
* Patient may appear [[Fatigue|fatigued]] | |||
===Vital signs=== | ===Vital signs=== | ||
* High grade spiking [[fever]] (spike during evening time)<ref name="pmid28546530">{{cite journal |vauthors=Feuerstein JL, Klein DE, Mikhitarian MA, Mehta A |title=Quotidian High Spiking Fevers in Adult Still's Disease |journal=Am J Case Rep |volume=18 |issue= |pages=580–588 |date=May 2017 |pmid=28546530 |pmc=5453396 |doi= |url=}}</ref> | |||
* [[Tachycardia]] | |||
*[[Pulsus paradoxus]] in case of [[pericardial tamponade]] | |||
===Skin=== | ===Skin=== | ||
* Salmon colored [[maculopapular rash]] on [[trunk]] and [[extremities]].<ref name="pmid9914890">{{cite journal |vauthors=Sunderkötter C, Frieling U, Nashan D, Metze D |title=[Adult-onset Still's disease and its characteristic rash] |language=German |journal=Hautarzt |volume=49 |issue=12 |pages=920–4 |date=December 1998 |pmid=9914890 |doi= |url=}}</ref> | |||
===HEENT=== | ===HEENT=== | ||
* Within normal limits | |||
===Neck=== | ===Neck=== | ||
* [[Lymphadenopathy]]<ref name="pmid15452159">{{cite journal |vauthors=Jeon YK, Paik JH, Park SS, Park SO, Kim YA, Kim JE, Song YW, Kim CW |title=Spectrum of lymph node pathology in adult onset Still's disease; analysis of 12 patients with one follow up biopsy |journal=J. Clin. Pathol. |volume=57 |issue=10 |pages=1052–6 |date=October 2004 |pmid=15452159 |pmc=1770453 |doi=10.1136/jcp.2004.018010 |url=}}</ref> | |||
===Lungs=== | ===Lungs=== | ||
* [[Pleural friction rub]] secondary to [[pleuritis]]<ref name="pmid22992345">{{cite journal |vauthors=Quartuccio L, Salvin S, Zuliani F, Mansutti E, De Vita S |title=Pleuritis is a red flag for adult-onset Still's disease which may require biologic therapies |journal=Clin. Exp. Rheumatol. |volume=30 |issue=5 |pages=807 |date=2012 |pmid=22992345 |doi= |url=}}</ref> | |||
* [[Rales]] and [[crackles]] due to [[pulmonary edema]] | |||
===Heart=== | ===Heart=== | ||
* [[Pericardial friction rub]] due to [[pericarditis]]<ref name="pmid8869216">{{cite journal |vauthors=Masson C, Le Loët X, Lioté F, Renou P, Dubost JJ, Boissier MC, Brithmer L, Brégeon C, Audran M |title=Adult Still's disease: part I. Manifestations and complications in sixty-five cases in France |journal=Rev Rhum Engl Ed |volume=62 |issue=11 |pages=748–57 |date=December 1995 |pmid=8869216 |doi= |url=}}</ref> | |||
===Abdomen=== | ===Abdomen=== | ||
* [[Hepatosplenomegaly]]<ref name="pmid12630021">{{cite journal |vauthors=Andrès E, Kurtz JE, Perrin AE, Pflumio F, Ruellan A, Goichot B, Dufour P, Blicklé JF, Brogard JM, Schlienger JL |title=Retrospective monocentric study of 17 patients with adult Still's disease, with special focus on liver abnormalities |journal=Hepatogastroenterology |volume=50 |issue=49 |pages=192–5 |date=2003 |pmid=12630021 |doi= |url=}}</ref> | |||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Rheumatology]] | |||
Latest revision as of 14:19, 23 April 2018
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Adult-onset Still's disease |
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Differentiating Adult-onset Still’s Disease from other Diseases |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
On physical examination, a patient suffering from adult-onset Still's disease (AOSD) may appear fatigued, has a high grade fever (spiking fever), tachycardia, salmon colored maculopapular rash on trunk and/or extremities, lymphadenopathy, hepatosplenomegaly, pleural and pericardial friction rub (due to underlying pleuritis and pericarditis).
Physical Examination
On physical examination, the following findings may be observed:[1][2][3][4]
Appearance of the patient
- Patient may appear fatigued
Vital signs
- High grade spiking fever (spike during evening time)[5]
- Tachycardia
- Pulsus paradoxus in case of pericardial tamponade
Skin
- Salmon colored maculopapular rash on trunk and extremities.[6]
HEENT
- Within normal limits
Neck
Lungs
- Pleural friction rub secondary to pleuritis[8]
- Rales and crackles due to pulmonary edema
Heart
Abdomen
References
- ↑ Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H, Kashiwazaki S, Tanimoto K, Matsumoto Y, Ota T (March 1992). "Preliminary criteria for classification of adult Still's disease". J. Rheumatol. 19 (3): 424–30. PMID 1578458.
- ↑ Kastner DL, Aksentijevich I, Goldbach-Mansky R (March 2010). "Autoinflammatory disease reloaded: a clinical perspective". Cell. 140 (6): 784–90. doi:10.1016/j.cell.2010.03.002. PMC 3541025. PMID 20303869.
- ↑ Oba Y, Abu-Salah T (2012). "The prevalence and diagnostic significance of eosinophilic pleural effusions: a meta-analysis and systematic review". Respiration. 83 (3): 198–208. doi:10.1159/000327200. PMID 21576924.
- ↑ Antoniou KM, Margaritopoulos GA, Giannarakis I, Choulaki C, Fountoulakis N, Siafakas NM, Sidiropoulos P (2013). "Adult Onset Still's Disease: A Case Report with a Rare Clinical Manifestation and Pathophysiological Correlations". Case Rep Med. 2013: 981232. doi:10.1155/2013/981232. PMC 3568868. PMID 23424598.
- ↑ Feuerstein JL, Klein DE, Mikhitarian MA, Mehta A (May 2017). "Quotidian High Spiking Fevers in Adult Still's Disease". Am J Case Rep. 18: 580–588. PMC 5453396. PMID 28546530.
- ↑ Sunderkötter C, Frieling U, Nashan D, Metze D (December 1998). "[Adult-onset Still's disease and its characteristic rash]". Hautarzt (in German). 49 (12): 920–4. PMID 9914890.
- ↑ Jeon YK, Paik JH, Park SS, Park SO, Kim YA, Kim JE, Song YW, Kim CW (October 2004). "Spectrum of lymph node pathology in adult onset Still's disease; analysis of 12 patients with one follow up biopsy". J. Clin. Pathol. 57 (10): 1052–6. doi:10.1136/jcp.2004.018010. PMC 1770453. PMID 15452159.
- ↑ Quartuccio L, Salvin S, Zuliani F, Mansutti E, De Vita S (2012). "Pleuritis is a red flag for adult-onset Still's disease which may require biologic therapies". Clin. Exp. Rheumatol. 30 (5): 807. PMID 22992345.
- ↑ Masson C, Le Loët X, Lioté F, Renou P, Dubost JJ, Boissier MC, Brithmer L, Brégeon C, Audran M (December 1995). "Adult Still's disease: part I. Manifestations and complications in sixty-five cases in France". Rev Rhum Engl Ed. 62 (11): 748–57. PMID 8869216.
- ↑ Andrès E, Kurtz JE, Perrin AE, Pflumio F, Ruellan A, Goichot B, Dufour P, Blicklé JF, Brogard JM, Schlienger JL (2003). "Retrospective monocentric study of 17 patients with adult Still's disease, with special focus on liver abnormalities". Hepatogastroenterology. 50 (49): 192–5. PMID 12630021.