Abstract
A case of adult onset Still's disease (AOSD) with the elevation of antistreptolysin O (ASO) and antistreptokinase (ASK) titers is presented.
A 38-year-old female admitted to the Yokosuka National Hospital because of high grade fever (39.6°C), skin eruption, myalgia and arthralgia in November, 1988.
On physical examination, body temperature was 38.4°C. Bilateral knee joints were slightly swollen but not deformed. Cervical lymphadenopathy and salmon-pink coloured rash were seen. Laboratory data showed leukocytosis (14, 300/mm3), anemia, thrombocytosis, elevated erythrocyte sedimentation rate (135mm/h.), positive C-reactive protein (10.3mg/dl) and mild liver function abnormalities. Serological test for rheumatoid factor and antinuclear antibody were not demonstrated. However, highly elevated ASO and ASK titers were noted. Multiple blood, urine, and oropharyngeal cultures were negative.
AOSD was diagnosed by these clinical and laboratory findings.
Low dose methylprednisolone was effective for her clinical signs and laboratory features. ASO and ASK titers were gradually decreased.
It was suggested that systemic response for streptococcal infection might be likely to be implicated in the pathogenesis of this case.
