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Distinct immune activation patterns in adult-onset Still's disease with fungal infections

Tongxin Wu1, Ye Yu1, Xuesong Liu1,2

  • 1Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Frontiers in Immunology
|April 16, 2026
PubMed
Abstract

Insights

Adult-onset Still's disease (AOSD) patients with fungal infections show distinct immune changes, including elevated neutrophil CD64 and CD8+ T cell activation. These findings highlight specific immune profiles in AOSD patients experiencing fungal infections.

Area of Science:

  • Immunology
  • Rheumatology
  • Infectious Diseases

Background:

  • Fungal infections are rare but serious complications in adult-onset Still's disease (AOSD).
  • The immune system's response in AOSD patients with fungal infections is not well understood.

Purpose of the Study:

  • To characterize the immune activation profiles of AOSD patients who develop fungal infections.
  • To identify specific immunological markers associated with fungal infections in AOSD.

Main Methods:

  • Retrospective analysis of 277 AOSD patients, comparing 35 with fungal infections to those without.
  • Evaluation of clinical features and immunological parameters: neutrophil CD64 (nCD64), myeloid-derived suppressor cells (MDSCs), T cell activation, and serum cytokines.

Main Results:

  • Patients with fungal infections had higher rates of splenomegaly, pulmonary infiltrates, and pericarditis.
  • Significantly elevated nCD64, CD8+ T cell activation (CD8+CD38+), and serum soluble IL-2R were observed in the infection group.
  • Elevated IL-8, IL-10, and ferritin were associated with fungal infections, even after adjusting for disease activity and treatment.

Conclusions:

  • AOSD patients with fungal infections display unique immune activation patterns involving neutrophils and CD8+ T cells.
  • These distinct immunological features may aid in assessing immune status and guiding treatment strategies for AOSD patients, especially those on immunosuppressants.
Keywords:
Adult-onset Still’s diseasefungal infectionimmune activationimmunobiologyoutcome

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