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Brain microhemorrhages in adult-onset Still's disease: A case report
Jung Youn Kim1, Hye Jeong Choi, Sang Heum Kim
1Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Rationale:
Adult-onset Still's disease (AOSD) is a rare, systemic inflammatory disease. Neurological involvement in AOSD has rarely been reported. In this case report, we describe a 44-year-old male patient with AOSD who presented with seizures and scattered microhemorrhages on brain magnetic resonance imaging (MRI). We recommend brain MRI evaluation, including susceptibility-weighted imaging (SWI), for patients with AOSD who exhibit neurological symptoms.
Patient Concerns:
A 44-year-old male patient presented to the clinic for a strikingly high fever, sore throat and myalgia that persisted for 3 weeks. The vital signs were stabilized upon empirical treatment after admission. On the 11th day after admission, he showed high spiking fever (up to 39.9°C) and generalized tonic-colonic seizure for 5 minutes. Extremely elevated serum ferritin level (≥16,500 ng/mL) was noted over the detection limit. Brain MRI with SWI showed multiple tiny dark signals in the splenium of the corpus and the subcortical white matter.
Diagnoses:
AOSD was diagnosed based on the Yamaguchi criteria.
Interventions:
Nonsteroidal anti-inflammatory drugs (NSAID), Tacrolimus, Hydroxychloroquine, and anticonvulsants.
Outcomes:
The patient recovered and the seizures did not recur.
Lessons:
Brain MRI evaluation, including SWI, is essential for patients with AOSD who present with neurological symptoms.
Insights
Adult-onset Still's disease (AOSD) can cause neurological issues like seizures. Brain MRI with SWI is crucial for diagnosing these rare complications in AOSD patients.
Area of Science:
- Neurology
- Rheumatology
- Radiology
Background:
- Adult-onset Still's disease (AOSD) is a rare systemic inflammatory condition.
- Neurological manifestations in AOSD are infrequently reported.
- This case highlights a patient with AOSD presenting with neurological symptoms.
Purpose of the Study:
- To report a case of AOSD with neurological involvement.
- To emphasize the utility of brain MRI in diagnosing AOSD-related neurological complications.
Main Methods:
- A 44-year-old male with persistent fever, sore throat, and myalgia was evaluated.
- Diagnosis of AOSD was confirmed using the Yamaguchi criteria.
- Brain MRI, including susceptibility-weighted imaging (SWI), was performed due to neurological symptoms (seizures).
Main Results:
- The patient experienced high spiking fevers and generalized tonic-clonic seizures.
- Extremely elevated serum ferritin levels were observed.
- Brain MRI with SWI revealed microhemorrhages in the corpus callosum and subcortical white matter.
Conclusions:
- Neurological symptoms in AOSD patients warrant thorough investigation.
- Brain MRI, particularly SWI, is essential for detecting AOSD-related brain abnormalities.
- Prompt diagnosis and management led to patient recovery and seizure resolution.
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