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A TRIAD OF FEATURES: Adult onset Still's disease (ASD) is an uncommon disorder usually associating high spiking fever, evanescent skin rash constituted of small salmon pink macules, and arthritis. NUMEROUS SYSTEMIC MANIFESTATIONS: A sore throat is common and often misleading. More than 60% of the patients develop mobile and indolent lymph nodes, usually in the cervical area. Liver involvement is common and usually limited to a mild or moderate cytolysis. However, several observations of severe hepatitis have been reported justifying strict monitoring of the liver biology in these patients. Amongst the other numerous systemic manifestations that have been reported, pericarditis is common and sometimes responsible for tamponade, the pulmonary involvement may lead to an acute respiratory distress, and the rare neurological manifestations include aseptic meningitis or cranial nerve palsy. FROM A BIOLOGICAL POINT OF VIEW: The sedimentation rate is consistently elevated and there is usually a marked elevation in the polymorphonuclears. The bacteriological survey is negative as are the immunological tests. An increase in the serum level of IL-18 might be both diagnostic and prognostic. It is the increase of the serum level of ferritin and the marked decrease in its glycosylated fraction below 20% that seem to be of more potent diagnostic value.

Introduction: Ankylosing spondylitis is a chronic inflammatory disorder that is rarely associated with severe systemic manifestations., Exegesis: We report the case of a 29-year-old man presenting with an atypical ankylosing spondylitis. The patient presented with a high spiking fever, a marked weight loss, and an unusual increase of acute phase response markers. Such features are rarely associated with ankylosing spondylitis and the review of the few similar reported cases in the literature showed that this presentation is usually associated with a severe disease course, and an asymmetrical joint involvement that is unresponsive to nonsteroidal anti-inflammatory agents., Conclusion: Clinicians should be aware of this unusual presentation of ankylosing spondylitis, which should be included in the list of aetiologies of fever of unknown origin, to avoid useless diagnostic procedures. The severity of the disease course may lead to the consideration of a more aggressive treatment strategy.

Accurate measurement of body temperature is essential in routine medical practice. Development of new measurement methods, and awareness of mercury hazards are leading to the modification of our current practices. The range of body temperature in healthy individuals is 36.8 +/- 0.4 degrees C, but it may be influenced by many factors. Therefore, body temperature should be measured in a standardized fashion, preferably at rest, in the morning on waking. Febrile state is generally defined as a morning rectal temperature above 37.5 degrees C. Body temperature is largely dependent of the site of measurement. Rectal temperature is the highest, and oral temperature measured in the sublingual pocket close to the lingual artery generally the lowest. Tympanic membrane temperature is assumed to best reflect the core temperature. Axillary and cutaneous measures are unreliable. Mercury-in-glass thermometer used to measure rectal temperature still remains the reference in France. However, rectal measurement is inconvenient and associated with a risk of rectal injury and cross-infection. Moreover, mercury-in-glass thermometer results in high mercury pollution. Tendency is to replace it by either electronic thermometer to measure oral temperature, or infrared thermometer for tympanic membrane measure. Although reliable, chemical measures are still underused.

We report the case of an 81 year-old woman admitted because of declining general health, fever and elevated sedimentation rate. Identification of a pelvic mass on the computed tomographic scan led to perform hysterectomy with a working diagnosis of ovarian malignancy. Histological examination revealed typical lesions of polyarteritis nodosa of uterus and fallopian tube vessels. Diffuse process of the vasculitis was suggested by persistence of fever and elevated erythrocyte sedimentation rate after hysterectomy. Treatment consisting of high-dose corticosteroids and pulses of cyclophosphamide resulted in prompt clinical and biological improvement. We discuss the incidence, the clinical features and the localized or diffuse nature of genital involvement in polyarteritis nodosa and other vasculitis.

Thirty patients (19 females, 11 males), with a mean age of 42 +/- 21 years, who presented a fever associated with a normal sedimentation rate prospectively studied. Mean fever duration at admission was 11 days (range: 1-90). Diagnosis included bacterial (12 cases) or viral (9 cases) infections, malaria (2 cases), systemic disease (2 cases), abnormal temperature control (2 cases) and lymphoma (1 cases). One patient simulated fever, and in the remaining case fever was of unknown origin. Identified factors implied in the mechanisms of normal sedimentation rate were: intravascular disseminated coagulation (5 cases), haemolysis (5 cases), late increase of inflammatory proteins (8 cases), red blood cell abnormalities (7 cases), cryoglobulinaemia (1 cases). This study suggests that the striking association of fever and normal sedimentation rate should lead clinicians to look for plasma and red blood cell abnormalities after ruling out a non inflammatory febrile disorder.

Increases in body temperature may be due to hyperthermia, i.e. imbalance between production and elimination of heat, or to fever, i.e. disregulation of the central thermostat by a humoral mediator now identified as interleukin I. The same mediator is involved in the production by the liver of inflammation proteins which, besides other actions, encourage the formation of rouleaux and produce an increase in erythrocyte sedimentation rate. However, it is not exceptional to find a rise in temperature associated with a normal erythrocyte sedimentation rate. When this situation does not reflect a technical error, it may guide the diagnostic approach of a febrile state and may suggest the existence of a non-inflammatory hyperthermia or of a fever associated with "paradoxical" normalisation of the erythrocyte sedimentation rate. The 1st hypothesis raises the possibility of a series of diagnoses ranging from fever of central origin to hyperthyroidism and drug-induced fever. The 2nd hypothesis leads to a search for plasma factors (low plasma fibrinogen level, hyperviscosity, cryoglobulin) or erythrocytic factors (polycythaemia, haemoglobinopathy) which inhibits the joining of red cells and artificially lower the erythrocyte sedimentation rate.

Introduction. – Ankylosing spondylitis is a chronic inflammatory disorder that is rarely associated with severe systemic manifestations.Exegesis. – We report the case of a 29-year-old man presenting with an atypical ankylosing spondylitis. The patient presented with a high spiking fever, a marked weight loss, and an unusual increase of acute phase response markers. Such features are rarely associated with ankylosing spondylitis and the review of the few similar reported cases in the literature showed that this presentation is usually associated with a severe disease course, and an asymmetrical joint involvement that is unresponsive to nonsteroidal anti-inflammatory agents.Conclusion. – Clinicians should be aware of this unusual presentation of ankylosing spondylitis, which should be included in the list of aetiologies of fever of unknown origin, to avoid useless diagnostic procedures. The severity of the disease course may lead to the consideration of a more aggressive treatment strategy. [ABSTRACT FROM AUTHOR]