两例成人斯蒂尔病的延迟诊断:抗核抗体阳性和结核病流行地区的诊断难题。

Perdana Aditya Rahman, Pandu Tridana Sakti
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摘要

成人型斯蒂尔病(AoSD)是一种罕见的系统性自身炎症性疾病,病因不明,好发于青壮年。在此,我们报告了两例延迟诊断的 AoSD 病例,在转诊前,患者最初被诊断为结核性关节炎和系统性红斑狼疮(SLE)。在第一个病例中,结核性关节炎是根据干扰素-γ释放检测阳性结果开始治疗的,而在第二个病例中,系统性红斑狼疮是根据临床症状和抗核抗体阳性结果诊断的。根据初步诊断、患者转诊或诊断阐述进行治疗后,临床症状没有改善。经过进一步评估,临床和实验室特征均符合 AoSD 的诊断。两名患者都有贫血、发热、关节炎和高铁蛋白水平,在接受大剂量甲基强的松龙治疗后,又接受了甲氨蝶呤治疗,临床症状有所改善,铁蛋白水平也有所降低。
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Delayed diagnosis of adult onset Still's disease in 2 cases: diagnostic dilemma in positive antinuclear antibody and tuberculosis endemic areas.

Adult-onset Still's disease (AoSD) is a rare systemic autoinflammatory disorder of unknown etiology that affects young adults. Here, we report two cases of delayed AoSD diagnosis, which was initially diagnosed as tuberculous arthritis and systemic lupus erythematosus (SLE) before referral. In the first case, tuberculous arthritis treatment was commenced based on positive interferon-gamma release assay results, whereas in the second case, SLE was diagnosed based on clinical symptoms and positive antinuclear antibody results. There was no clinical improvement after treatment based on the initial diagnosis, patient referral, or diagnostic elaboration. After further evaluation, the clinical and laboratory features were found to be appropriate for the diagnosis of AoSD. Both patients had anemia, fever, arthritis, and high ferritin levels and were treated with high-dose methylprednisolone followed by methotrexate; clinical improvement was observed, and the ferritin levels reduced.

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