Carpal tunnel syndrome with both AA amyloidosis and elderly-onset Still disease: A case report

This study reports a rare case of both AA amyloidosis and elderly-onset Still disease presenting as fever following carpal tunnel syndrome surgery.

A 79-year-old man reported numbness, pain, and muscle weakness in his right hand for several months.

We performed carpal tunnel opening surgery and a synovial biopsy because of significant synovial tissue in the carpal tunnel. A pathological examination revealed amyloid tissue deposition in the interstitium around the blood vessels and between the muscle bundles. He developed a postoperative fever. Blood biochemical tests revealed elevated neutrophils and blood sedimentation as well as high C-reactive protein, serum amyloid A protein, and ferritin levels. He was diagnosed with adult Still disease, and the carpal tunnel syndrome was suspected to have resulted from AA amyloidosis.

With steroid pulse therapy, his inflammatory response, fever, joint pain, and swelling rapidly improved.

In the first year postoperative, the clinical findings improved and patient-reported outcomes were good.

Elderly-onset Still disease presents as an unknown fever after carpal tunnel release surgery and is likely caused by AA amyloidosis in older men. Here, we detailed a rare case of both AA amyloidosis and adult-onset Still disease diagnosed of the carpal tunnel's synovial membrane.