抄録
A 40-year-old woman presented with fever, polyarthritis, and a recurrent rash on the trunk and thighs. She was initially diagnosed with adult-onset Still’s disease (AOSD) based on elevated serum ferritin and matrix metalloproteinase-3, and on normal antinuclear anti-cyclic citrullinated peptide and anti-cytoplasmic antibody levels. Chlamydia trachomatis immunoglobulin (Ig)A and cytomegalovirus (CMV) IgM positivity indicated co-infection. Magnetic resonance imaging revealed hepatomegaly and periportal edema, suggesting Fitz-Hugh-Curtis syndrome. The patient’s plasma adrenocorticotropic hormone level was extremely low. The patient was treated with azithromycin, tosufloxacin, and erythromycin for 7 weeks, recovered without sequelae, and remained asymptomatic for 22 months. HLA typing revealed the presence of B51; HLA typing is considered important for the identification of CMV disease. Because of the variety of symptoms that can occur in overlapping and mixed infections, general practitioners should be aware of these when encountering connective tissue disease-like symptoms.
