診断に苦慮した成人Still病の1例

A case report of adult Still's disease with difficult diagnosis

はじめに

　耳鼻咽喉科は咽頭痛，発熱，リンパ節腫脹などを主訴とする上気道感染症の治療を行うことが多い。そのなかで，速やかに症状が改善せず遷延化して治療に苦慮する症例をしばしば経験する。一般に成人Still病は内科で診断・治療する疾患のため耳鼻咽喉科医が遭遇することは少ない疾患であり，発熱，皮疹，関節炎を主な症状とする以外には，検査所見の少ない疾患である^1）。今回われわれは，咽頭痛・頸部痛で来院し診断に苦慮した患者を経験したので，文献的考察を加えて報告する。

　A 16-year-old male presented with complaints of sore throat, high fever, and difficulty swallowing. Peritonsillar abscess or cervical lymphadenitis was firstly suspected and antibiotics were administered. Tracheotomy was tried 4 days later since the local symptom was not improved. Adult Still's disease was suspected because of continuous high fever, another physical symptoms and blood test results. This disease is characterized with fever, eruption and arthralgia. In addition, sore throat and a swelling of cervical lymph nodes frequently appeared. The symptom of this patient was well controlled with steroid therapy. Otolaryngologist should aware of this disease in patients with continuous high fever.