伴肝功能异常的成人Still病误诊三例报告并文献复习

摘要

目的 探讨成人Still病(adult-onset Still's disease, AOSD)的不典型临床表现,以减少误诊误治.方法 回顾分析伴肝功能异常的3例AOSD临床资料,并复习相关文献.结果 3例均以不明原因发热就诊,均有肝功能异常,曾误诊为药物性肝损伤和(或)急性肝炎和(或)肝脓肿,使用大量抗生素和保肝药物治疗后未见好转.转我院后,根据患者临床症状及相关医技检查结果,诊断AOSD,给予糖皮质激素等治疗后症状随即好转.随访均未再发热,肝功能正常.结论 肝功能异常可以是部分AOSD患者的特点之一,临床遇及发热、关节痛、皮疹、咽痛、肝脾淋巴结增大、血白细胞升高、中性粒细胞升高、铁蛋白升高、肝功能异常者,当大量抗生素治疗无效时,在排除感染、肿瘤、风湿性疾病后,应考虑到AOSD的可能.%Objective To investigate clinically atypical manifestations of adult-onset Still's disease (AOSD) to decrease misdiagnosis and mistreatment.Methods Clinical data of 3 patients with AOSD associated by abnormal liver function was retrospectively analyzed, and related literature was reviewed.Results All the 3 patients visited doctors for fever of undetermined origin and abnormal liver function, and were misdiagnosed as having drug-induced liver injury and (or) acute hepatitis and (or) liver abscess, but the patients' conditions did not improve after using lots of antibiotics and hepatic protectant medicines.After being transferred to our hospital, AOSD was confirmed according to clinical symptoms and medical examination results.Patients' conditions turned better after glucocorticoid treatment.All patients had no fever again with normal liver function during follow-up.Conclusion The abnormal liver function can be one of the features of part of the ASOD patients.Clinicians should consider possibility of AOSD for patients with the clinical manifestations of fever, joint pain, rash, sore throat, liver spleen lymphadenovarix, increased blood leukocytes, neutrophil granulocytes and ferroprotein and abnormal liver function have no effect after lots of antibiotics treatment, and the possibilities of infection, tumour or rheumatic immunologic diseases are excluded.