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Refractory Relapsing-Remitting Adult-Onset Still's Disease in an Adolescent Female: A Rare Case Report
Tasnim Nafian1, Mohd Mujtaba Akib Bhuiyan1, Kazi Ali Aftab1
1Department of Internal Medicine Bangladesh Medical University Dhaka Bangladesh.
Clinical Case Reports
|August 6, 2026
Summary
Adult-onset Still's disease (AOSD) is a rare autoinflammatory condition. This case highlights the challenges in treating relapsing AOSD, showing biologic therapy (tocilizumab) may be needed for persistent symptoms.
Area of Science:
- Rheumatology
- Immunology
- Internal Medicine
Background:
- Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder characterized by fever, rash, arthritis, and systemic inflammation.
- Its relapsing-remitting course presents diagnostic and therapeutic challenges.
Purpose of the Study:
- To present a case of AOSD in an 18-year-old female with a multi-year history of flares.
- To illustrate the stepwise escalation of treatment from conventional disease-modifying antirheumatic drugs (DMARDs) to biologic therapy.
Main Methods:
- Diagnosis of AOSD was based on the Yamaguchi criteria after excluding other conditions.
- The patient was treated with corticosteroids, conventional DMARDs (methotrexate), and subsequently biologic therapy (tocilizumab).
Main Results:
- The patient experienced multiple relapses despite initial treatments, indicating a polycyclic disease pattern.
- Tocilizumab provided temporary remission, but flares recurred during steroid tapering, necessitating dose adjustments and pulse corticosteroid therapy.
Conclusions:
- AOSD often exhibits a relapsing-remitting course, posing treatment difficulties.
- Escalation to IL-6 receptor inhibition (tocilizumab) is crucial for DMARD-refractory, relapsing AOSD, requiring dose optimization for sustained remission.
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