Adult-Onset Still's Disease: An Atypical Presentation Refractory to Standard Treatment

Area of Science:

• Rheumatology
• Infectious Diseases
• Hematology

Background:

• Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder.
• Viral infections are known triggers for AOSD in susceptible individuals.

Observation:

• A young female presented with polyarthritis, rash, sore throat, and weight loss.
• Initial workup revealed parvovirus B19 infection and hyperferritinemia.
• Bone marrow biopsy indicated hemophagocytic lymphohistiocytosis.

Findings:

• The patient was diagnosed with AOSD secondary to parvovirus B19 infection.
• The presentation was atypical, complicated by macrophage activation syndrome.
• The condition was refractory to standard treatment.

Implications:

• This case underscores the diverse clinical manifestations of AOSD.
• It highlights the diagnostic complexities of AOSD, particularly when co-occurring with hemophagocytic lymphohistiocytosis.
• Challenges in managing treatment-refractory AOSD are emphasized.