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Published on: June 16, 2020
Case Report on Pulmonary Involvement in a Patient with Adult Still's Disease
Leonid Dvoretsky1, Anna Torgashina2, Svetlana Rachina1
1Internal Medicine Department #2, Sechenov First Moscow State Medical University, Moscow, Russian Federation.
Background:
Pulmonary manifestations and lung impairment are rarely associated with the Adult Still's Disease and are reported in less than 5%.
Case Presentation:
The present clinical case describes the Adult Still's Disease with pulmonary involvement in a 45- year-old male. The main clinical manifestations included continuous fever, failure to respond to antibiotic therapy, skin rashes, musculoskeletal syndrome and pharyngitis. Additionally, bronchopulmonary lymphadenopathy, interstitial changes and dense foci with clear contours were detected in the lungs. Laboratory abnormalities included neutrophilic leukocytosis, increased ALT, AST, and elevated serum inflammatory marker levels. A cyclical course characterised the disease with strictly defined time intervals between flare-ups and remissions. After the prescription of methylprednisolone with the subsequent addition of methotrexate, complete regression of clinical symptoms, normalization of laboratory tests, and partial regression of computed tomography findings in the lungs were observed.
Conclusion:
Despite the low incidence, pulmonary involvement is an unfavorable manifestation of Adult Still's Disease. An individual feature of this case report was the asymptomatic lung involvement manifested only by changes revealed through computed tomography. For a long time, flareups of the disease were considered bacterial infections of unclear nature requiring systemic antibiotics.
Insights
Adult Still's Disease rarely affects the lungs, but this case shows it can occur. Early diagnosis and treatment with corticosteroids and methotrexate led to symptom and lung finding improvement.
Area of Science:
- Rheumatology
- Pulmonology
- Internal Medicine
Background:
- Adult Still's Disease (ASD) is a rare systemic inflammatory disorder.
- Pulmonary involvement in ASD is infrequent, occurring in less than 5% of cases.
Observation:
- A 45-year-old male presented with classic ASD symptoms: fever, rash, musculoskeletal pain, and pharyngitis.
- Pulmonary involvement was noted via computed tomography (CT) showing lymphadenopathy and interstitial changes.
- Initial symptoms were misdiagnosed as bacterial infections, delaying appropriate treatment.
Findings:
- The patient exhibited neutrophilic leukocytosis, elevated liver enzymes (ALT, AST), and high inflammatory markers.
- A cyclical disease course with distinct flare-ups and remissions was observed.
- Treatment with methylprednisolone and methotrexate resulted in clinical remission and partial resolution of CT findings.
Implications:
- Pulmonary involvement in ASD, though rare, can be an unfavorable prognostic indicator.
- Asymptomatic lung changes on CT can be the sole manifestation of pulmonary ASD.
- This case highlights the importance of considering ASD in patients with persistent, unexplained inflammatory symptoms and atypical lung findings.
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