Still's Disease in a 70-Year-Old Woman

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Abstract
IN 1971, Bywaters1reported adultonset Still's disease in 14 patients older than 16 years. The usual clinical picture is that of a young adult with high spiking fever, malaise, a maculopapular rash, and any of numerous associated findings. Laboratory abnormalities are nonspecific. Systemic manifestations often precede the development of arthritis by years, making this a diagnosis to be considered when evaluating fever of undetermined origin. Report of a Case A 70-year-old woman was referred to the Medical College of Virginia, Richmond, in June 1980 for further evaluation of an episodic fever of undetermined origin. The fever had been present for two years and had led to five hospital admissions. The patient had previously been treated for right-calf thrombophlebitis, daily fevers, and dry, hacking cough. In October 1978, severe anterior pleuritic chest pain developed. Pleurocentesis yielded 60 mL of yellow, cloudy fluid found to be exudative (WBC count, 15,300/cu mm,

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