Urticaria as a presenting manifestation of adult-onset Still's disease

Adult-onset Still's disease (AOSD) is a rare disorder of unknown aetiology, characterised by high spiking fever, an evanescent, erythematous, maculopa pular rash, arthralgia or arthritis, lymphadenopathy, hepatosplenomegaly, s ore throat and serositis. It is associated with marked leukocytosis, high e rythrocyte sedimentation rate, increased level of serum ferritin and negati ve rheumatoid factor and antinuclear antibody tests. Here we report a patie nt in whom an urticaria-like rash was an uncommon presenting clinical featu re of AOSD. To our knowledge, this association has only been reported once before.