A Case Report of Still’s Disease in the Adult

Abstract

Adult Still's disease (ASD) is a rare systemic inflammatory disorder of unknown etiology, typically characterized by a clinical triad (daily spiking high fevers, evanescent rash, and arthritis) and a biological triad (hyperferritinemia, hyperleucocytosis with neutrophilia and abnormal liver function test). There are no specific diagnostic tests for ASD, so the diagnosis of ASD remains one of exclusion and the differential diagnosis may be lengthy. We present a case of an adultonset Still's disease with previous admissions for fever of unknown origin with a 2-month history of fever and systemic symptoms. The patient posteriorly presented polyarthralgies and cutaneous rash. The study disclosed anemia, inflammatory markers and hepatic enzymes elevation, and negative serological and immunological studies. The introduction of corticotherapy resolved symptoms and laboratories alterations. Adult-onset Still disease is a heterogeneous and rare disease and the lack of serologic markers as a true gold standard makes diagnosis difficult.

Paving a Shorter Path Towards Diagnosis: A Case on Adult Onset Still’s Disease from Pakistan

“…Furthermore, as the path towards reaching the AOSD diagnosis is so lengthy, it is natural that several prior diagnoses are made along the way, in as many as 80% of the patients [ 14 ]. Our patient was misdiagnosed as a case of malaria and enteric fever, the latter being the perceived diagnosis for 6.66% of AOSD patients in a previous Pakistani study as well [ 10 ]. Other cases in the past have been treated as rheumatic fever, infectous mononeucleosis, systemic lupus erythmatosis, polyarthritis nodosa, Henoch-Schönlein purpura, tuberculosis in most Third World countries where it is prevalent, Lyme disease and gonococcal meningitis—all reportedly due to the overlapping symptoms of fever, sore throat, and arthralgia [ 15 ].…”

“…The global incidence of AOSD is approximately 0.6 per 100,000 people per year [ 9 ] with an interestingly higher incidence obtained from Canada and from a series of fever of unknown origin (FUO) patients from Turkey [ 8 ]. Most studies have described either a female preponderance or equal distribution between the sexes [ 10 ] with a male preponderance reported only from the South Asian population [ 11 ]. This disparity may very well be due to the fact that significantly lesser females seek medical care in the Third World countries in the region, thus counting for unreported cases and misrepresented statistics.…”