A man with inflamed ears

A 23-year-old man presented with fever, dyspnea, nonproductive cough, left eye redness, reduced vision, and bilateral ear pain and tenderness. The sym ptoms had begun two days earlier, eight days after he was discharged from t he hospital with a presumptive diagnosis of Still's disease. He was first s een a month before the current admission for complaints of fever (as high a s 39.4 degrees C), nonproductive cough, and asymmetric arthritis. The worku p at that time included arthrocentesis of the right knee. Analysis of the j oint fluid showed 7,500 white blood cells/mm(3) and no crystals. A gram sta in and culture of the fluid were negative, HIV and hepatitis tests, bone ma rrow biopsy and culture, transesophageal echocardiography, abdominal comput ed tomography, radionuclide bone scanning, and rheumatologic tests failed t o identify the problem. The development of an evanescent macular pink rash on day 15 suggested the possibility of Still's disease. Treatment with pred nisone (40 mg po qd) was initiated, and the patient was discharged on day 1 9.