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The diagnostic dilemma of adult-onset Still's disease: a case report
Manoj Kumar Yadav1, Aarati Rauniyar2, Lalkiran Gharti Magar2
1Department of Rheumatology, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal.
Introduction And Importance:
Adult-onset Still's disease (AOSD) is a rare auto-inflammatory disorder, characterized by high-grade fever, arthritis, and a variety of systemic signs/symptoms. AOSD is very often misdiagnosed because of the overlapping clinical features, necessitating a thorough differential diagnosis, especially in cases of fever of unknown origin (FUO).
Case Presentation:
A 55-year-old male with high-grade fever, myalgia, and arthralgia for the past 4 weeks. Yamaguchi criteria for AOSD met following an extensive evaluation. Laboratory findings showed leukocytosis with neutrophilic predominance, elevated ferritin levels, and mild abnormalities in liver function tests. The patient was started on intravenous corticosteroids, followed by oral corticosteroids in tapering dose of the drug and the introduction of methotrexate as a steroid-sparing agent (DMARDs).
Clinical Discussion:
The case illustrates the diagnostic challenges associated with AOSD in older persons and the importance to consider this condition in the context of a FUO. The diagnosis of AOSD remains exclusive, yet effective management typically involves corticosteroids and DMARDs.
Conclusion:
AOSD, though rare, can occur uncommonly in older populations. This case highlights the need for awareness among clinicians to ensure early diagnosis and appropriate management, ultimately aiding in better outcomes of patient.
Insights
Adult-onset Still's disease (AOSD) can present atypically in older adults, often mimicking fever of unknown origin (FUO). Early diagnosis and prompt treatment with corticosteroids and DMARDs are crucial for better patient outcomes.
Area of Science:
- Rheumatology
- Internal Medicine
- Auto-inflammatory Diseases
Background:
- Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder.
- Characterized by fever, arthritis, and systemic symptoms, AOSD often presents with overlapping features, leading to diagnostic challenges.
- Misdiagnosis is common, particularly in older adults and cases of fever of unknown origin (FUO).
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