Any health condition that weakens the immune system may cause a swollen lymph node, and more often than not it is not a purpose for concern. PAFPA often follows a pattern of sickness that reappears, ultimately going away between the ages of 10 and 20. J Rheumatol 2001 28(2):322-329.A swollen gland within the neck is likely one of the common signs of this condition, often with fever, sore throat, and mouth sores. Diagnostic value of ferritin and glycosylated ferritin in adult onset Still's disease. Gerfaud-Valentin M, Jamilloux Y, Iwaz J, Sève P. Yamaguchi M, Ohta A, Tsunematsu T, et al Preliminary criteria for classification of adult Still's disease. Fever of unexplained origin: Report on 100 cases. A low percentage of glycosylated fraction of ferritin is another pointer to the diagnosis, but it cannot be determined in most laboratories in South Africa. However, the key findings in this case of unrelenting quotidian fever, evanescent rash, marked neutrophilia, and ferritin >10 000 μ g/L are highly suggestive of AOSD. As steroids suppress fever and inflammation, idiopathic PUO would respond to this treatment because its natural history is to abate. When the aetiological diagnosis eludes the clinician, patients with PUO are often diagnosed as having AOSD. ![]() The patient fulfilled the Yamaguchi criteria ( Table 3) for AOSD, with a good clinical and laboratory response to prednisone 80 mg once daily. A computed tomography (CT) scan and Doppler test excluded retropharyngeal abscess and Lemierre's syndrome. ![]() A fourth-generation HIV enzyme-linked immunosorbent assay (ELISA) was negative. A slightly enlarged left adenoid was noted that exuded a small volume of pus on biopsy, while histology revealed lymphoid hyperplasia. On admission to tertiary care, an aetiological differential diagnosis for the pyrexia of unknown origin (PUO) ( Table 2) included retropharyngeal abscess, Lemierre's syndrome, HIV seroconversion, and adult-onset Still's disease (AOSD). The relevant laboratory investigations are shown in Table 1. Shotty cervical lymphadenopathy was noted. He did not respond to ceftriaxone and had a continual significant fever daily. Ten days into his illness he was admitted to a regional hospital with an ongoing painful throat, generalised myalgia, fever (38.5☌) and a transient, recurring, salmon-pink rash on his hands and trunk. He did not respond to ceftriaxone and had a continual significant fever daily.Ī 20-year-old man presented with a severely sore throat and myalgia, which were unresponsive to antibiotics. He was admitted to a regional hospital with an ongoing painful throat, generalised myalgia, fever and a transient, recurring, salmon-pink rash on his hands and trunk. ![]() IIIFCP (SA), Cert ID (SA) Phys Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaĪ 20-year-old man presented with a severely sore throat and myalgia, which were unresponsive to antibiotics. IIPhD, FRCP Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa IFCP (SA) Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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