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T1 Date 3 13 March 2009 E1 Date:T1 T2 Age 17 28 21-year-old T3 Sex 29 32 man T4 Activity 37 45 admitted E2 Activity:T4 T5 Nonbiological_location 49 68 another institution R1 MODIFY Arg1:T5 Arg2:E2 T6 Sign_symptom 99 104 fever E3 Sign_symptom:T6 T7 Frequency 86 98 intermittent R2 MODIFY Arg1:T7 Arg2:E3 T8 Sign_symptom 106 114 headache E4 Sign_symptom:T8 T9 Sign_symptom 116 131 polyarthralgias E5 Sign_symptom:T9 T10 Sign_symptom 138 142 rash E6 Sign_symptom:T10 T11 Biological_structure 133 137 skin T12 Biological_structure 152 157 trunk R3 MODIFY Arg1:T12 Arg2:E6 R4 MODIFY Arg1:T11 Arg2:E6 T13 Sign_symptom 163 172 petechiae E7 Sign_symptom:T13 T14 Sign_symptom 226 233 healthy E8 Sign_symptom:T14 T15 History 215 233 previously healthy T16 History 239 263 no history of drug abuse T17 History 274 295 no regular medication T18 History 309 316 no pets T19 History 321 346 had not traveled recently T20 Sign_symptom 446 451 fever E9 Sign_symptom:T20 T21 Severity 441 445 high R5 MODIFY Arg1:T21 Arg2:E9 T22 Diagnostic_procedure 463 491 maximum axillary temperature E10 Diagnostic_procedure:T22 T23 Quantitative_concept 493 499 >39 °C R6 MODIFY Arg1:T23 Arg2:E10 T24 Biological_structure 180 187 fingers T25 Biological_structure 192 197 palms R7 MODIFY Arg1:T24 Arg2:E7 R8 MODIFY Arg1:T25 Arg2:E7 T26 Sign_symptom 527 536 headaches E11 Sign_symptom:T26 T27 Date 395 411 one month before E12 Date:T27 T28 Activity 412 421 admission E13 Activity:T28 T29 Sign_symptom 562 572 arthralgia E14 Sign_symptom:T29 T30 Detailed_description 552 561 symmetric T31 Detailed_description 538 547 bilateral T32 Biological_structure 580 586 wrists T33 Biological_structure 591 596 hands R9 MODIFY Arg1:T32 Arg2:E14 R10 MODIFY Arg1:T33 Arg2:E14 R11 MODIFY Arg1:T30 Arg2:E14 R12 MODIFY Arg1:T31 Arg2:E14 T34 Date 3349 3365 Ten months after E15 Date:T34 T35 Activity 3389 3398 presented E16 Activity:T35 T36 Nonbiological_location 3406 3417 institution R13 MODIFY Arg1:T36 Arg2:E16 T37 Activity 3424 3439 follow-up visit E17 Activity:T37 T38 Activity 3106 3116 discharged E18 Activity:T38 T39 Nonbiological_location 3126 3134 hospital R14 MODIFY Arg1:T39 Arg2:E18 T40 Medication 3151 3161 prednisone E19 Medication:T40 T41 Sign_symptom 753 757 rash E20 Sign_symptom:T41 T42 Detailed_description 726 736 evanescent T43 Color 738 752 salmon-colored R15 MODIFY Arg1:T43 Arg2:E20 R16 MODIFY Arg1:T42 Arg2:E20 T44 Detailed_description 606 626 inflammatory pattern R17 MODIFY Arg1:T44 Arg2:E14 T45 Sign_symptom 629 638 petechiae E21 Sign_symptom:T45 T46 Biological_structure 648 653 palms R18 MODIFY Arg1:T46 Arg2:E21 T47 Biological_structure 658 665 fingers R19 MODIFY Arg1:T47 Arg2:E21 T48 Sign_symptom 682 686 rash E22 Sign_symptom:T48 T49 Color 667 681 salmon-colored R20 MODIFY Arg1:T49 Arg2:E22 T50 Biological_structure 694 699 trunk R21 MODIFY Arg1:T50 Arg2:E22 T51 Sign_symptom 701 707 nausea E23 Sign_symptom:T51 T52 Sign_symptom 713 721 vomiting E24 Sign_symptom:T52 T53 Biological_structure 778 783 chest T54 Biological_structure 788 795 abdomen R22 MODIFY Arg1:T53 Arg2:E20 R23 MODIFY Arg1:T54 Arg2:E20 T55 Distance 801 805 2-mm T56 Sign_symptom 806 815 petechiae E25 Sign_symptom:T56 R24 MODIFY Arg1:T55 Arg2:E25 T57 Biological_structure 828 833 palms T58 Biological_structure 842 849 fingers R25 MODIFY Arg1:T57 Arg2:E25 R26 MODIFY Arg1:T58 Arg2:E25 T59 Disease_disorder 870 879 arthritis E26 Disease_disorder:T59 A1 POLARITY E26 NEG T60 Sign_symptom 898 913 lymphadenopathy E27 Sign_symptom:T60 A2 POLARITY E27 NEG T61 Sign_symptom 917 935 hepatosplenomegaly E28 Sign_symptom:T61 A3 POLARITY E28 NEG T62 Diagnostic_procedure 937 950 Blood testing E29 Diagnostic_procedure:T62 T63 Diagnostic_procedure 967 987 inflammatory markers E30 Diagnostic_procedure:T63 T64 Qualitative_concept 958 966 elevated R27 MODIFY Arg1:T64 Arg2:E30 R28 SUB_PROCEDURE Arg1:E30 Arg2:E29 T65 Diagnostic_procedure 1004 1024 electrocardiographic E31 Diagnostic_procedure:T65 T66 Diagnostic_procedure 1026 1029 ECG E32 Diagnostic_procedure:T66 R29 IDENTICAL Arg1:E32 Arg2:E31 T67 Biological_structure 1035 1040 chest T68 Diagnostic_procedure 1041 1053 radiographic E33 Diagnostic_procedure:T68 R30 MODIFY Arg1:T67 Arg2:E33 T70 Medication 1075 1084 Ibuprofen E34 Medication:T70 T71 Dosage 1086 1096 1,200 mg/d T72 Medication 1102 1115 acetaminophen E35 Medication:T72 T73 Sign_symptom 1152 1163 symptomatic E36 Sign_symptom:T73 A4 POLARITY E36 MAYBE_NEG T74 Diagnostic_procedure 1185 1195 evaluation E37 Diagnostic_procedure:T74 T75 Diagnostic_procedure 1221 1235 blood cultures E38 Diagnostic_procedure:T75 T76 Diagnostic_procedure 1257 1274 serologic studies E39 Diagnostic_procedure:T76 T77 Detailed_description 1237 1256 viral and bacterial R33 MODIFY Arg1:T77 Arg2:E39 T78 Diagnostic_procedure 1276 1297 immunologic screening E40 Diagnostic_procedure:T78 T79 Diagnostic_procedure 1299 1316 rheumatoid factor E41 Diagnostic_procedure:T79 T80 Diagnostic_procedure 1321 1343 antinuclear antibodies E42 Diagnostic_procedure:T80 T81 Diagnostic_procedure 1350 1370 computed tomographic E43 Diagnostic_procedure:T81 T82 Diagnostic_procedure 1372 1374 CT E44 Diagnostic_procedure:T82 R34 IDENTICAL Arg1:E44 Arg2:E43 T83 Biological_structure 1391 1396 chest T84 Biological_structure 1398 1405 abdomen T85 Biological_structure 1407 1413 pelvis T86 Biological_structure 1419 1426 cranium R35 MODIFY Arg1:T83 Arg2:E43 R36 MODIFY Arg1:T84 Arg2:E43 R37 MODIFY Arg1:T85 Arg2:E43 R38 MODIFY Arg1:T86 Arg2:E43 T87 Diagnostic_procedure 1474 1502 transthoracic echocardiogram E45 Diagnostic_procedure:T87 T88 Diagnostic_procedure 1504 1507 TTE E46 Diagnostic_procedure:T88 R39 IDENTICAL Arg1:E46 Arg2:E45 T89 Sign_symptom 1538 1558 pericardial effusion E47 Sign_symptom:T89 T90 Severity 1533 1537 mild R40 MODIFY Arg1:T90 Arg2:E47 T91 Detailed_description 1516 1531 circumferential R41 MODIFY Arg1:T91 Arg2:E47 T92 Sign_symptom 1602 1611 tamponade E48 Sign_symptom:T92 A5 POLARITY E48 NEG T93 Diagnostic_procedure 1560 1576 maximal diameter E49 Diagnostic_procedure:T93 T94 Lab_value 1578 1582 8 mm E50 Lab_value:T94 R42 MODIFY Arg1:E50 Arg2:E49 T95 Sign_symptom 1684 1688 pain E51 Sign_symptom:T95 T96 Sign_symptom 1658 1665 dyspnea E52 Sign_symptom:T96 T97 Biological_structure 1678 1683 chest R43 MODIFY Arg1:T97 Arg2:E51 T98 Detailed_description 1670 1677 diffuse R44 MODIFY Arg1:T98 Arg2:E51 T99 Date 1640 1656 A few days later E53 Date:T99 T100 Sign_symptom 1704 1708 pain E54 Sign_symptom:T100 A6 POLARITY E54 NEG T101 Activity 1731 1742 anteflexion E55 Activity:T101 T102 Biological_structure 1725 1730 chest R45 MODIFY Arg1:T102 Arg2:E55 T103 Activity 1766 1777 inspiration E56 Activity:T103 T104 Detailed_description 1761 1765 deep R46 MODIFY Arg1:T104 Arg2:E56 T105 Activity 1785 1797 lying supine E57 Activity:T105 T106 Sign_symptom 1815 1826 hypotensive E58 Sign_symptom:T106 T107 Sign_symptom 1828 1839 tachycardic E59 Sign_symptom:T107 T108 Sign_symptom 1845 1855 hyperpneic E60 Sign_symptom:T108 T109 Sign_symptom 1890 1900 distention E61 Sign_symptom:T109 T110 Biological_structure 1875 1889 jugular venous R47 MODIFY Arg1:T110 Arg2:E61 T111 Diagnostic_procedure 1906 1909 ECG E62 Diagnostic_procedure:T111 T112 Sign_symptom 1947 1967 ST-segment elevation E63 Sign_symptom:T112 T113 Sign_symptom 1923 1934 tachycardia E64 Sign_symptom:T113 T114 Detailed_description 1917 1922 sinus R48 MODIFY Arg1:T114 Arg2:E64 T115 Detailed_description 1939 1946 diffuse R49 MODIFY Arg1:T115 Arg2:E63 T116 Diagnostic_procedure 1987 1997 radiograph E65 Diagnostic_procedure:T116 T117 Biological_structure 1981 1986 chest R50 MODIFY Arg1:T117 Arg2:E65 T118 Sign_symptom 2010 2018 enlarged E66 Sign_symptom:T118 T119 Biological_structure 2019 2026 cardiac R51 MODIFY Arg1:T119 Arg2:E66 T120 Diagnostic_procedure 2055 2075 inflammatory markers E67 Diagnostic_procedure:T120 T121 Lab_value 2087 2095 elevated E68 Lab_value:T121 R52 MODIFY Arg1:E68 Arg2:E67 T122 Diagnostic_procedure 2117 2120 TTE E69 Diagnostic_procedure:T122 T123 Sign_symptom 2147 2167 pericardial effusion E70 Sign_symptom:T123 A7 TREND E70 INC T124 Distance 2187 2192 12 mm R53 MODIFY Arg1:T124 Arg2:E70 T125 Sign_symptom 2206 2214 collapse E71 Sign_symptom:T125 T126 Biological_structure 2222 2242 right heart chambers R54 MODIFY Arg1:T126 Arg2:E71 T127 Therapeutic_procedure 2254 2272 pericardiocentesis E72 Therapeutic_procedure:T127 T128 Detailed_description 2244 2253 Emergency R55 MODIFY Arg1:T128 Arg2:E72 T129 Sign_symptom 2290 2311 serosanguineous fluid E73 Sign_symptom:T129 T130 Volume 2281 2286 60 mL R56 MODIFY Arg1:T130 Arg2:E73 T131 Diagnostic_procedure 2328 2330 CT E74 Diagnostic_procedure:T131 T132 Biological_structure 2338 2343 chest T133 Biological_structure 2348 2355 abdomen T134 Sign_symptom 2392 2408 pleural effusion E75 Sign_symptom:T134 T135 Sign_symptom 2426 2433 ascites E76 Sign_symptom:T135 T136 Severity 2421 2425 mild R57 MODIFY Arg1:T136 Arg2:E76 T137 Severity 2365 2369 mild T138 Detailed_description 2370 2375 right T139 Severity 2380 2386 severe T140 Detailed_description 2387 2391 left R58 MODIFY Arg1:T140 Arg2:E75 R59 MODIFY Arg1:T138 Arg2:E75 R60 MODIFY Arg1:T139 Arg2:T140 R61 MODIFY Arg1:T137 Arg2:T138 T141 Therapeutic_procedure 2435 2450 Thoracocentesis E77 Therapeutic_procedure:T141 T142 Sign_symptom 2494 2523 serosanguineous pleural fluid E78 Sign_symptom:T142 T143 Volume 2484 2490 350 mL R62 MODIFY Arg1:T143 Arg2:E78 T144 Diagnostic_procedure 2600 2625 microbiologic examination E79 Diagnostic_procedure:T144 T145 Lab_value 2591 2599 negative E80 Lab_value:T145 R63 MODIFY Arg1:E80 Arg2:E79 T146 Diagnostic_procedure 2653 2672 histologic analysis E81 Diagnostic_procedure:T146 T147 Lab_value 2635 2647 unremarkable E82 Lab_value:T147 R64 MODIFY Arg1:E82 Arg2:E81 T148 Detailed_description 2557 2563 fluids T149 Biological_structure 2552 2556 lung T150 Biological_structure 2542 2547 heart R65 MODIFY Arg1:T149 Arg2:T148 R66 MODIFY Arg1:T150 Arg2:T148 R67 MODIFY Arg1:T148 Arg2:E79 R68 MODIFY Arg1:T148 Arg2:E81 T151 Disease_disorder 2691 2695 AOSD E83 Disease_disorder:T151 #1 AnnotatorNotes E83 Adult-onset Still's disease T152 Detailed_description 428 440 intermittent R69 MODIFY Arg1:T152 Arg2:E9 T153 Medication 2733 2742 medicated E84 Medication:T153 T154 Medication 2748 2758 prednisone E85 Medication:T154 T155 Dosage 2760 2771 0.5 mg/kg/d R70 MODIFY Arg1:T155 Arg2:E85 T156 Sign_symptom 2809 2820 improvement E86 Sign_symptom:T156 T157 Sign_symptom 2848 2872 ST-segment normalization E87 Sign_symptom:T157 T158 Diagnostic_procedure 2892 2906 echocardiogram E88 Diagnostic_procedure:T158 T159 Severity 2919 2923 mild T160 Sign_symptom 2924 2944 pericardial effusion E89 Sign_symptom:T160 R71 MODIFY Arg1:T159 Arg2:E89 T161 Distance 2946 2952 2–3 mm R72 MODIFY Arg1:T161 Arg2:E89 T162 Disease_disorder 2963 2985 hemodynamic compromise E90 Disease_disorder:T162 A8 POLARITY E90 NEG T163 Diagnostic_procedure 2987 2996 Screening E91 Diagnostic_procedure:T163 T164 Disease_disorder 3027 3036 disorders E92 Disease_disorder:T164 A9 POLARITY E92 NEG T165 Detailed_description 3016 3026 infectious T166 Detailed_description 3001 3011 autoimmune R73 MODIFY Arg1:T165 Arg2:E92 R74 MODIFY Arg1:T166 Arg2:E92 T167 Sign_symptom 3213 3221 effusion E93 Sign_symptom:T167 T168 Detailed_description 3205 3212 pleural T169 Detailed_description 3189 3200 pericardial R75 MODIFY Arg1:T168 Arg2:E93 R76 MODIFY Arg1:T169 Arg2:E93 T170 Date 3222 3236 2 months after E94 Date:T170 T171 Clinical_event 3237 3246 discharge E95 Clinical_event:T171 T172 Medication 3254 3268 corticosteroid E96 Medication:T172 A10 POLARITY E96 NEG T173 Medication 3329 3339 prednisone E97 Medication:T173 T174 Outcome 3448 3460 asymptomatic E98 Outcome:T174 T175 Medication 3483 3497 corticosteroid E99 Medication:T175 T176 Diagnostic_procedure 3517 3520 ECG E100 Diagnostic_procedure:T176 T177 Diagnostic_procedure 3525 3528 TTE E101 Diagnostic_procedure:T177 T178 Lab_value 3536 3558 no significant changes E102 Lab_value:T178 T179 Lab_value 3055 3077 no significant changes E103 Lab_value:T179 R77 MODIFY Arg1:E103 Arg2:E91 R78 MODIFY Arg1:E102 Arg2:E101 R79 MODIFY Arg1:E102 Arg2:E100 * OVERLAP E1 E2 E3 E4 E5 E6 E7 R80 AFTER Arg1:E7 Arg2:E8 R81 BEFORE Arg1:E8 Arg2:E12 R82 BEFORE Arg1:E12 Arg2:E13 R83 AFTER Arg1:E13 Arg2:E9 * OVERLAP E9 E10 E11 E14 E21 E22 E23 E24 E20 E25 E26 E27 E28 R84 BEFORE Arg1:E28 Arg2:E29 * OVERLAP E29 E31 E33 T69 Lab_value 1067 1073 normal E104 Lab_value:T69 R31 MODIFY Arg1:E104 Arg2:E33 R32 MODIFY Arg1:E104 Arg2:E31 R85 BEFORE Arg1:E33 Arg2:E34 R86 MODIFY Arg1:T71 Arg2:E34 T180 Dosage 1117 1126 as needed R87 MODIFY Arg1:T180 Arg2:E35 * OVERLAP E34 E35 R88 BEFORE Arg1:E35 Arg2:E36 * OVERLAP E36 E37 E38 E39 E40 E43 E45 E47 E49 E48 R89 SUB_PROCEDURE Arg1:E41 Arg2:E40 R90 SUB_PROCEDURE Arg1:E42 Arg2:E40 T181 Lab_value 1428 1450 No significant changes E105 Lab_value:T181 R91 MODIFY Arg1:E105 Arg2:E37 R92 BEFORE Arg1:E48 Arg2:E53 * OVERLAP E53 E52 E51 R93 BEFORE Arg1:E51 Arg2:E54 * OVERLAP E54 E55 E106 E56 E57 E58 E59 E60 E61 E62 E64 E63 E65 E66 E67 E69 E70 E71 T182 Therapeutic_procedure 1731 1742 anteflexion E106 Therapeutic_procedure:T182 R94 BEFORE Arg1:E71 Arg2:E72 * OVERLAP E72 E73 E74 E75 E76 R95 MODIFY Arg1:T132 Arg2:E74 R96 MODIFY Arg1:T133 Arg2:E74 R97 BEFORE Arg1:E76 Arg2:E77 * OVERLAP E77 E78 E79 E81 R98 BEFORE Arg1:E81 Arg2:E83 * OVERLAP E83 E84 R99 SUB_PROCEDURE Arg1:E85 Arg2:E84 R100 BEFORE Arg1:E84 Arg2:E86 T183 Detailed_description 2798 2808 laboratory T184 Detailed_description 2785 2793 clinical R101 MODIFY Arg1:T184 Arg2:E86 R102 MODIFY Arg1:T183 Arg2:E86 * OVERLAP E86 E87 E88 E89 E90 E91 E92 R103 BEFORE Arg1:E92 Arg2:E18 * OVERLAP E18 E19 R104 BEFORE Arg1:E19 Arg2:E93 * OVERLAP E93 E94 R105 AFTER Arg1:E94 Arg2:E95 * OVERLAP E95 E96 R106 BEFORE Arg1:E96 Arg2:E97 R107 BEFORE Arg1:E97 Arg2:E15 * OVERLAP E15 E16 E17 E98 E99 E100 E101