Characteristic fever of adult onset Stills disease

Characteristic fever of adult onset Stills disease

The classically described fever in AOSD typically starts suddenly and rapidly reaches ≥39°C. The fever generally occurs only once a day, usually in the late afternoon or early evening and lasts 2 to 4 hours. The fever occurs daily for over a week and typically longer.

Characteristically, the patient’s temperature returns to normal or below normal between fever spikes. This pattern is known as a quotidian fever .

In 20% of cases, the patient may have an additional early morning spike (double quotidian fever) .

The differential of a double quotidian fever is limited to AOSD, kala-azar, mixed malarial infections, Kawasaki’s disease, right-sided gonococcal or meningococcal endocarditis, and miliary tuberculosis (TB). Note that in up to 20% of cases of AOSD, the patient’s temperature may not completely normalize between fever spikes. This is particularly likely in patients who develop MAS.

Patients with AOSD generally fit into two described presentations: one with more systemic features and one with more chronic articular disease. Patients with high fevers feel very ill when febrile but feel relatively well when their body temperature is normal. This poses a dilemma for physicians, because hospital rounds and clinic visits may not occur during the times when the patient is febrile. The fever pattern in Still’s disease contrasts with the pattern seen in the setting of infection; infections generally cause a baseline elevation in body temperature in addition to episodic or erratic fever spikes.

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