To the Editor.—
Regarding the brief report by Scopelitis and colleagues,1 we concur with their conclusion that a diagnosis of Still's disease or systemic rheumatoid arthritis (RA) should not be overlooked because of the absence of leukocytosis. In fact, in previous reports2,3 of 20 children with systemic RA, one had a normal white blood cell count and the other was leukopenic. Leukocytosis was present in 18 children (90%), with a WBC count between 10,000 and 20,000/cu mm in two patients, 20,000 and 30,000 in ten, 30,000 and 50,000 in five, and up to 80,000 in one. Moreover, in a recent review of 17 adults with systemic RA, two had leukopenia, and the WBC count was normal in one.4 Consequently, since leukopenia is uncommon in systemic RA, it is critical to rule out other causes of high fever, rash, and arthritis-arthralgia, especially SLE and leukemia. Nevertheless, the two
Calabro JJ, Londino AV, Eyvazzadeh C. Leukopenia in Still's Disease. JAMA. 1985;253(15):2194. doi:10.1001/jama.1985.03350390035014
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