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La complejidad del diagnóstico en la inflamación sistémica: la enfermedad de Still de inicio adulto
Kevin Rivera1, Caitlin Kesari2
1Internal Medicine, Mount Carmel Health System, Columbus, USA.
Cureus
|February 20, 2026
Resumen
La enfermedad de Still de inicio en adultos (AOSD, por sus siglas en inglés) es una rara condición autoinflamatoria. Este caso pone de relieve los desafíos de diagnóstico, especialmente cuando están presentes cristales de dihidrato de pirofosfato de calcio (CPPD), enfatizando la necesidad de una correlación clínica cuidadosa.
Área de la Ciencia:
- Reumatología Reumatología.
- Medicina interna es la medicina interna de las enfermedades.
- Inmunología Inmunología.
Sus antecedentes:
- La enfermedad de Still de inicio adulto (AOSD) es un raro trastorno autoinflamatorio sistémico caracterizado por fiebre, erupción cutánea y artritis.
- El diagnóstico se basa en la presentación clínica y la exclusión de otras afecciones como infecciones, tumores malignos y enfermedades reumatológicas.
- La hiperferritinemia es un hallazgo de laboratorio clave en el AOSD.
Objetivo del estudio:
- Para describir un caso desafiante de AOSD en un hombre nigeriano.
- Para ilustrar las complejidades de diagnóstico que surgen de la detección simultánea de cristales CPPD.
- Para enfatizar la importancia del contexto clínico en el diagnóstico de AOSD.
Principales métodos:
- Informe de caso de un hombre nigeriano de 33 años con fiebre persistente, artralgia, dolor de garganta y sarpullido.
- Investigaciones de laboratorio que incluyen ferritina, PCR y leucocitosis.
- Aspiración conjunta para el análisis de cristales.
- La exclusión de la infección, la malignidad, la linfohistiocitosis hemofagocítica y el síndrome de activación de los macrófagos.
- Diagnóstico de AOSD basado en criterios de clasificación y evaluación clínica.
- El tratamiento con corticosteroides, anakinra, canakinumab y metotrexato.
Principales resultados:
- El paciente presentó síntomas que imitaban la reacción alérgica y la infección, progresando a pesar de los tratamientos iniciales.
- Se observó hiperferritinemia marcada (hasta 14.000 ng/mL) y leucocitosis.
- La aspiración de la rodilla reveló cristales de CPPD, lo que complica el diagnóstico.
- La mejoría clínica se produjo con altas dosis de corticosteroides, seguido de terapia biológica.
- AOSD fue diagnosticado después de excluir otras posibles etiologías.
Conclusiones:
- La detección de cristales de CPPD puede complicar el diagnóstico de la artritis inflamatoria en sospecha de AOSD.
- Un diagnóstico unificador requiere una correlación clínica cuidadosa y la exclusión de condiciones alternativas.
- La inflamación autoinmune sistémica debe considerarse incluso con hallazgos de cristales coexistentes.
- El manejo adecuado de la AOSD puede incluir corticosteroides y agentes biológicos dirigidos.
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