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Adult-Onset Still’s Disease - a Clinical Case

Joana Andonova, Violeta Dimitrova, Kalina Chavdarova, Maria Dimova, Vesela Zlateva

Abstract

Introduction: Adult-onset Still’s disease (AOSD) is a type of systemic onset juvenile idiopathic arthritis. Major criteria include high spiking fevers > 38.5 °C, arthralgia or arthritis, a transient, nonpruritic salmon-colored rash and leukocytosis. Minor criteria may include sore throat, lymphadenopathy, negative rheumatoid factor, abnormal liver function tests, hepatomegaly or splenomegaly. Five criteria are needed for diagnosis with at least two of them being major. The condition may present with a sudden onset and symptoms may disappear and never occur again after treatment initiation, it may also turn into a chronic arthritis or, if affecting internal organs, may lead to severe complications.

Materials and Methods: This is a clinical case of a 24-year-old female whose symptoms started during pregnancy and continued postpartum. Therefore, she  was admitted to St. Marina University Hospital, Varna for diagnostic management. Symptoms included fever of 38.6 °C, a rash affecting the upper body and limbs, joint pain and edema in the knees, wrists and ankles with a duration of one month. Antibiotic treatment that was initiated during that period of time did not account to any improvement of the patient’s condition and the fever persisted.

Results: A number of clinical examinations and laboratory tests were carried out to exclude sepsis condition or an underlying autoimmune disorder and the patient was diagnosed with AOSD. Treatment with glucocorticoids- Urbason 60 mg, NSAIDs and gastroprotectants was immediately initiated. The rash and joint pain disappeared and an improvement of the patient’s condition was reported.

Conclusions: This clinical case is an example of a patient with fever of unknown origin and contributes to the fact that Still’s disease is a diagnosis of exclusion but should be taken into account in the process of diagnosing and managing unexplained fever conditions.


Keywords

adult-onset Still’s disease


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