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Newly diagnosed adult-onset Still disease in pregnancy
Vivien L Pan1, Atsuko Z Haruyama, Cristiane Guberman
1Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, California, USA. vpan@usc.edu
Background:
Adult-onset Still disease is a rare febrile disorder that can present for the first time during pregnancy. It is a diagnosis of exclusion with nonspecific laboratory results. Good maternal and fetal outcomes can be expected after initial diagnosis and treatment.
Case:
A 21-year-old (gravida 2, para 1) at 20 weeks' gestation presented with fever, malaise, arthralgias, and cough. She had an extensive evaluation that led to the diagnosis of adult-onset Still disease. She was treated with prednisone and had immediate improvement. She delivered a viable infant at 34 weeks after suspected intrauterine growth restriction and continued to have recurrent symptoms postpartum. The second woman, 38 years old and gravida 3, para 1, aborta 1, presented at 22 weeks' gestation with similar symptoms and also had a similar diagnostic evaluation. She was diagnosed with adult-onset Still disease and started on prednisone, with immediate improvement, delivering a viable infant at 41 weeks' gestation.
Conclusion:
Adult-onset Still disease in pregnancy can be confused with many other diseases, but its diagnosis, after exclusion of other infectious, malignant, and rheumatic conditions, can portend good maternal and fetal outcomes.