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Horiuchi Y, Hashimoto K, Horikoshi H, Sano A, Kawamura Y, Fujita N, Kimata M, Ono Y, Obuchi Y, Makino A, Kaneko M, Kimura F, Itoh K, Tanaka Y. Fulminant elderly adult-onset Still disease effectively treated with tocilizumab and methotrexate: A case report. Medicine (Baltimore) 2022; 101:e29354. [PMID: 35839054 PMCID: PMC11132312 DOI: 10.1097/md.0000000000029354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Adult-onset Still disease (AOSD) is a rare inflammatory disease of unknown etiology. AOSD is common in young or middle-aged adults; however, in recent years, there have been increasing reports of elderly AOSD. Differentiating AOSD from diseases such as infections and malignancies is difficult. Moreover, rare fulminant AOSD cases with resistance to corticosteroids and immunosuppressive drugs have been reported. PATIENT CONCERNS An 80-year-old woman presented with flaccid fever, generalized arthralgia, and erythema of the anterior chest for 2 weeks. On day 5 of hospitalization, the patient developed pleural effusion with hypoxemia and her vital signs indicated rapid progression to shock. During the clinical course, the levels of inflammatory markers, including maximum level of ferritin and white blood cells (WBCs) were elevated (252,796 ng/mL and 86,500/μV, respectively) with disseminated intravascular coagulation syndrome (DIC) and macrophage activation syndrome (MAS). DIAGNOSIS The patient was diagnosed with elderly AOSD as per the Yamaguchi criteria for AOSD. The state of disease was extremely severe with rapid progression and was, thus, categorized as a fulminant form of elderly AOSD. INTERVENTIONS The patient was treated with prednisolone (PSL) pulse therapy (1000 mg/d) twice and plasma exchange in the intensive care unit for the primary disease and shock. Although she recovered from shock, she developed DIC and MAS. Methotrexate (MTX; 10 mg/d) improved the DIC and MAS. However, severe pleuritis recurred and the patient developed pericarditis; her primary disease was poorly controlled. Finally, tocilizumab (TCZ) was introduced using interleukin-18 (IL-18) as a surrogate marker. The IL-18 level was measured repeatedly following admission, with the peak level (170,000 pg/mL) recorded on the 75th day of hospitalization, immediately prior to introducing TCZ. OUTCOMES The combined use of MTX, TCZ, and PSL was effective in suppressing elderly AOSD, which was unsuccessfully controlled with MTX and PSL. Frequent monitoring of IL-18 levels proved useful for differentiating elderly AOSD from other diseases. LESSONS A fulminant form of elderly AOSD was treated with a combination of MTX, TCZ, and PSL. Repeated monitoring of IL-18 levels can be useful for decision-making in treating elderly AOSD.
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Affiliation(s)
- Yugo Horiuchi
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Hideyuki Horikoshi
- Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Azusa Sano
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Yusuke Kawamura
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Naoya Fujita
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Motohiro Kimata
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Yasuhiro Obuchi
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Arisa Makino
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Mayuko Kaneko
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Fumihiko Kimura
- Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Kenji Itoh
- Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama
| | - Yuji Tanaka
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama
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Adult-Onset Still’s Disease with Dermatopathic Lymphadenitis Clinicopathologic Features: A Rare Case Report and Review of the Literature. Case Reports Immunol 2022; 2022:1653683. [PMID: 35693913 PMCID: PMC9187476 DOI: 10.1155/2022/1653683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Adult-onset Still’s disease (AOSD) is an inflammatory disorder characterized by fever, arthritis, and a transient skin rash. It is a rare condition characterized by inflammatory multisystem changes of unknown cause. A 35-year-old woman was admitted to rheumatology department of tertiary care hospital complaining of painful wrist and skin rash as well as fever, generalized lymphadenopathy, weight loss, and fatigue. The early diagnosis of AOSD was confirmed by clinical history, examination, and laboratory tests, as well as a confirmatory skin biopsy with typical histopathological features, namely, upper epidermal dyskeratosis and dermal inflammatory neutrophilic infiltration. The patient’s condition was treated with steroids and NSAIDs, to which she responded well, and on follow-up, her symptoms regressed along with improvement in biochemical parameters. The authors suggest that skin biopsy and confirmation of histopathological diagnosis of AOSD are useful in the diagnosis and proper management of AOSD patients in cases with clinical suspicion of AOSD.
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Suzuki E, Temmoku J, Fujita Y, Yashiro-Furuya M, Asano T, Kanno T, Migita K. Clinical Characteristics of Japanese Patients with Elderly-Onset Adult-Onset Still's Disease. TOHOKU J EXP MED 2021; 255:195-202. [PMID: 34759075 DOI: 10.1620/tjem.255.195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to compare the characteristics of Japanese patients with elderly-onset Adult-onset Still's disease (AOSD) and those with younger-onset AOSD. Patients were classified into elderly-onset (≥ 65 years, n = 20) and younger-onset (< 65 years, n = 62) groups according to age at AOSD diagnosis. Analyses included the comparison of clinical features, treatments, and Pouchot and modified Pouchot (mPouchot) scores between the two groups. The frequencies of sore throat, lymphadenopathy, and splenomegaly were significantly lower in the elderly-onset group than in the younger-onset group (30.5% vs. 80.6%, p = 0.0004; 15.0% vs. 54.8%, p = 0.0019; 30.0% vs. 61.3%, p = 0.0203; respectively). There were no significant differences in the frequencies of complications, such as macrophage activation syndrome and disseminated intravenous coagulation, between the patients with elderly-onset or younger-onset AOSD. Serum ferritin levels were higher in the elderly-onset group than in the younger-onset group, albeit without statistical significance (median, 9,423 vs. 4,164 ng/mL, p = 0.1727). Pouchot score was lower in the elderly-onset group than in the younger-onset group (median score, 5.5 vs. 4.0, p = 0.0008); however, there was no significant difference in the mPouchot score between the two groups. Our analyses revealed that elderly-onset AOSD was associated with certain characteristics that were distinct from those of younger-onset AOSD and that the disease severity in patients with elderly-onset AOSD, determined by Pouchot score at the time of AOSD diagnosis, was similar to or less than that in patients with younger-onset AOSD.
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Affiliation(s)
- Eiji Suzuki
- Department of Rheumatology, Fukushima Medical University School of Medicine.,Department of Rheumatology, Ohta-Nishinouchi Hospital
| | - Jumpei Temmoku
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | | | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Takashi Kanno
- Department of Rheumatology, Ohta-Nishinouchi Hospital
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine
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Abstract
Adult-onset Still’s disease is a rare inflammatory disorder usually affecting young adults. Elderly-onset Still’s disease (EOSD) is reported in some cases, commonly in Japan, the USA and Europe. One of the most commonly used criteria for diagnosing EOSD is Yamaguci criteria. In elderly patients more severe course of the disease and more complications may be expected than in the younger group of patients with Still’s disease. The lungs involvement is rather rare manifestation of this disease. In our article we discuss the problem of both the development of Still’s disease in the elderly and interstitial lung changes in the course of the disease, based on available literature and own cases from one centre.
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Adult onset Still's disease in the elderly: a case-based literature review. BMC Rheumatol 2021; 5:12. [PMID: 33875007 PMCID: PMC8056719 DOI: 10.1186/s41927-021-00183-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background Adult onset Still’s disease (AOSD) is a rare inflammatory disorder that classically presents with high spiking fevers, evanescent rash, and arthritis. The diagnosis is one of exclusion and can be further complicated by atypical presentations, particularly in elderly patients in whom AOSD is very rare. Case presentation A case of AOSD in a 73-year-old woman with a non-classic presentation, leading to delayed diagnosis and management, is presented along with a review of the English literature for AOSD cases in elderly people over 70 years of age. Thirty nine case reports and series were identified and the current case was added, totaling 42 individual cases. Significant findings included a four-times higher prevalence in females, a higher prevalence of macrophage activation syndrome despite lower mortality, the presence of pruritic rash in almost one fifth of the cases, and high prevalence of delayed diagnosis. Conclusions AOSD in the elderly may vary from the classic criteria described in the medical literature and may lead to delayed diagnosis and management. Further evaluation and better characterization of AOSD in the elderly remains an area of interest.
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Maruyama A, Kokuzawa A, Yamauchi Y, Kirino Y, Nagai H, Inoue Y, Ota T, Chifu Y, Inokuchi S, Koarada S, Ohta A, Iwamoto M, Tada Y. Clinical features of elderly-onset Adult-onset Still's disease. Mod Rheumatol 2020; 31:862-868. [PMID: 32990106 DOI: 10.1080/14397595.2020.1829340] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To clarify the characteristics of patients with elderly-onset Adult-onset Still's disease (AOSD). METHODS Patients were classified into elderly-onset (>60 years: 47 patients) and younger-onset (≤60 years: 95 patients) groups according to their age at diagnosis of AOSD. Clinical features, treatments, and prognosis were compared between the elderly-onset and younger-onset groups. RESULTS In the elderly-onset group, compared with the younger-onset group, typical skin rashes were less frequent (21.3% vs 58.9%, respectively; p < .0001), whereas pleuritis (27.7% vs 7.4%, respectively; p = .0011) and disseminated intravascular coagulation (19.1% vs 2.1%, respectively; p = .0004) were more frequent, and serum ferritin levels were higher (median 12,700 ng/ml vs 2526 ng/ml, respectively; p < .0001). Overall survival and AOSD-related survival were reduced (p = .0006 and p = .0023, respectively) and drug-free remission was less frequent (p = .0035) in the elderly-onset group compared with the younger-onset group. CONCLUSIONS Our results demonstrated that elderly-onset AOSD patients had several characteristics that differed from younger-onset AOSD patients, including less typical skin lesions, more AOSD-related complications, higher ferritin levels, and poorer prognoses.
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Affiliation(s)
- Akihito Maruyama
- Department of Rheumatology, Faculty of Medicine, Saga University, Saga, Japan
| | - Ayako Kokuzawa
- Department of Rheumatology and Clinical Immunology, Jichi Medical University, Shimotsuke, Japan
| | - Yusuke Yamauchi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideto Nagai
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasushi Inoue
- Division of Rheumatology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Toshiyuki Ota
- Center for Rheumatic Diseases, Iizuka Hospital, Iizuka, Japan
| | - Yutaka Chifu
- Division of Internal Medicine, Saiseikai Karatsu Hospital, Karatsu, Japan
| | - Satomi Inokuchi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Syuichi Koarada
- Department of Rheumatology, Faculty of Medicine, Saga University, Saga, Japan
| | - Akihide Ohta
- Suigo-en Kohokai Group Medical Corporation, Fukuoka, Japan
| | - Masahiro Iwamoto
- Department of Rheumatology and Clinical Immunology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshifumi Tada
- Department of Rheumatology, Faculty of Medicine, Saga University, Saga, Japan
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Borg J, Camilleri ML, Cassar PJ. Adult-onset Still's disease in a 73-year-old Maltese man. BMJ Case Rep 2020; 13:13/8/e234752. [PMID: 32859621 DOI: 10.1136/bcr-2020-234752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adult-onset Still's disease (AOSD) is a rare autoinflammatory condition diagnosed by Yamaguchi criteria. We report an atypical presentation of a 73-year-old man, who was admitted with fever, sore throat and pleurisy that were unresponsive to three courses of antibiotics. Fever persisted in a quotidian pattern and the typical salmon-coloured rash consistent with AOSD appeared at 4 weeks from symptoms onset. These features in addition to neutrophilia and hyperferritinaemia in the absence of concurrent infectious and neoplastic causes satisfied Yamaguchi criteria for a diagnosis of AOSD. Epstein-Barr antigen was initially detected at moderate titre levels, but was undetectable after 1 week. Complete resolution of symptoms was reported on initiation of steroid treatment. A relationship between disease onset and viral syndromes has been documented to occur and few similar cases preceded by Epstein-Barr virus detection have been reported.
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Affiliation(s)
- Janice Borg
- Department of Medicine, Mater Dei Hospital, Msida, Malta
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Suda T, Zoshima T, Takeji A, Suzuki Y, Mizushima I, Yamada K, Nakashima A, Yachie A, Kawano M. Elderly-onset Still's Disease Complicated by Macrophage Activation Syndrome: A Case Report and Review of the Literature. Intern Med 2020; 59:721-728. [PMID: 31708548 PMCID: PMC7086308 DOI: 10.2169/internalmedicine.3727-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Adult-onset Still's disease (AOSD) usually affects young adults. Some cases of elderly-onset Still's disease (EOSD) have been reported, but its clinical features are unclear. We herein report a 74-year-old woman who developed AOSD with macrophage activation syndrome (MAS). We also reviewed 24 previous EOSD cases in patients over 70 years old and compared the findings with overall AOSD. While the clinical features were similar between the two, including the presence of MAS, disseminated intravascular coagulation was more frequent in EOSD than in AOSD. Furthermore, despite a similar frequency of glucocorticoid use, immunosuppressants and biologics were less frequently administered in EOSD than in AOSD. This report highlights the fact that typical AOSD can develop in elderly patients with some characteristic features.
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Affiliation(s)
- Takuya Suda
- Department of Nephrology and Rheumatology, Ishikawa Prefectural Central Hospital, Japan
| | - Takeshi Zoshima
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, Japan
| | - Akari Takeji
- Department of Nephrology and Rheumatology, Ishikawa Prefectural Central Hospital, Japan
| | - Yasunori Suzuki
- Department of Nephrology and Rheumatology, Ishikawa Prefectural Central Hospital, Japan
| | - Ichiro Mizushima
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, Japan
| | - Kazunori Yamada
- Department of Hematology and Immunology, Kanazawa Medical University, Japan
| | - Akikatsu Nakashima
- Department of Nephrology and Rheumatology, Ishikawa Prefectural Central Hospital, Japan
| | - Akihiro Yachie
- Department of Pediatrics, Graduate School of Medical Sciences, Kanazawa University, Japan
| | - Mitsuhiro Kawano
- Department of Rheumatology, Kanazawa University Graduate School of Medicine, Japan
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Bhatia R, Kaeley N, Kant R, Basi A. Fever with persistent flagellate erythema in a primigravida: a rare presentation of adult-onset Still's disease. BMJ Case Rep 2019; 12:12/7/e229332. [PMID: 31302619 DOI: 10.1136/bcr-2019-229332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 25-year-old primigravida, who presented to the emergency department with fever, arthralgia and erythematous maculopapular eruption. There was confluent violaceous macular erythema on the arms, v-area of the neck and upper back with periorbital oedema, mimicking dermatomyositis. There was flagellate erythema on the back. Skin biopsy and systemic investigations helped to rule out dermatomyositis. A final diagnosis of adult-onset Still's disease with atypical cutaneous manifestations was made. This atypical variant is associated with a worse prognosis. Early recognition of this clinical variant can be life-saving for the patient.
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Affiliation(s)
- Riti Bhatia
- Dermatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nidhi Kaeley
- Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ravi Kant
- Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ankith Basi
- Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Mehta BY, Ibrahim S, Briggs W, Efthimiou P. Racial/Ethnic variations in morbidity and mortality in Adult Onset Still's Disease: An analysis of national dataset. Semin Arthritis Rheum 2019; 49:469-473. [PMID: 31109638 DOI: 10.1016/j.semarthrit.2019.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/20/2019] [Accepted: 04/22/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Adult Onset Still's Disease (AOSD) is a rare autoinflammatory disorder. There is relatively little known about the impact of social determinants of health on its outcomes. Our goal is to describe the racial/ethnic variations, morbidity and mortality of AOSD hospitalized patients in the US. MATERIALS AND METHODS Adult US hospitalized patients between 2009-13 from a nationwide inpatient sample (NIS) database with AOSD were identified using ICD-9 code 714.2. NIS is the largest all-payer US inpatient database with approximately 8 million hospitalizations yearly. Patients with other autoimmune diseases were excluded. We used descriptive statistics to summarize patient and hospital characteristics. We performed survey-weighted logistic regression models adjusting for confounders to study our primary outcome: in-hospital mortality. RESULTS Between 2009-13, 5,820 AOSD patients were hospitalized with a mean age of 53.6 (SE-0.61) years. 3817 (65.6%) were female, 56% white and 3% Asian. Macrophage Activating Syndrome (1.7%), Disseminated Intravascular Coagulation (DIC-1.1%) and Thrombotic Thrombocytopenic Purpura (0.4%), respectively, complicated the hospital course. There were 154 inpatient deaths in study period (mortality 2.6%). Mean age of patients who died in hospital was higher (62.4 years ± 3.1) and 13.9% were Asians. Patients of Asian origin had significantly higher odds of in-hospital death compared to whites (aOR = 6.39, 95% CI 1.77-23.1, p = 0.005). Mortality was significantly higher for patients whose hospital course was complicated by DIC (aOR = 29.69, 95% CI 5.5-160.41, p = 0.006). CONCLUSIONS In this national sample of patients hospitalized for AOSD, we found significant variations in In-hospital mortality.
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Affiliation(s)
- Bella Y Mehta
- Rheumatology, Hospital for Special Surgery, 535 E 70th St, New York, New York 10021, USA.
| | - Said Ibrahim
- Weill Cornell Medicine, 407 E 61st St, New York, NY 10065, USA
| | - William Briggs
- Weill Cornell Medicine, 407 E 61st St, New York, NY 10065, USA
| | - Petros Efthimiou
- Medicine/Rheumatology, New York University School of Medicine/NYU Langone Health, 550 1st Avenue, New York, NY 10016, USA
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Mahmood K, Mahmood S, Marsia S. Paving a Shorter Path Towards Diagnosis: A Case on Adult Onset Still's Disease from Pakistan. Cureus 2018; 10:e3255. [PMID: 30416905 PMCID: PMC6217873 DOI: 10.7759/cureus.3255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Adult onset Still’s disease (AOSD) is a rare clinical entity with unknown etiology, characterized by arthritis, fever, erythematous rash, and other systemic presentations. We report a case of a 21-year-old male who presented with high spiking fever, dry cough, generalized body ache, arthralgia, and an erythematous rash. He was eventually diagnosed to have AOSD based on the Yamaguchi criteria, after a month of visiting three different healthcare facilities and receiving two misdiagnoses and treatment regimes not specific to his diagnosis. The patient immediately responded to prednisoloneand was healthy upon discharge.
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Affiliation(s)
- Khalid Mahmood
- Department of Medicine, Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Samar Mahmood
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Shayan Marsia
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
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Dong MJ, Wang CQ, Zhao K, Wang GL, Sun ML, Liu ZF, Xu L. 18F-FDG PET/CT in patients with adult-onset Still’s disease. Clin Rheumatol 2015; 34:2047-56. [DOI: 10.1007/s10067-015-2901-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/11/2015] [Accepted: 02/14/2015] [Indexed: 10/23/2022]
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14
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Mehrpoor G, Owlia MB, Soleimani H, Ayatollahi J. Adult-onset Still’s disease: a report of 28 cases and review of the literature. Mod Rheumatol 2014. [DOI: 10.3109/s10165-008-0104-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Ertugrul BM, Gencer P, Ozturk B, Saylak Ersoy OM, Sakarya S. Adult-Onset Still's Disease in an 83-Year-Old. J Am Geriatr Soc 2012; 60:162-4. [DOI: 10.1111/j.1532-5415.2011.03735.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Bulent M. Ertugrul
- Department of Infectious Diseases and Clinical Microbiology; School of Medicine; University of Adnan Menderes; Aydin; Turkey
| | - Pelin Gencer
- Department of Infectious Diseases and Clinical Microbiology; School of Medicine; University of Adnan Menderes; Aydin; Turkey
| | - Barcin Ozturk
- Department of Infectious Diseases and Clinical Microbiology; School of Medicine; University of Adnan Menderes; Aydin; Turkey
| | - Ozlem M. Saylak Ersoy
- Department of Infectious Diseases and Clinical Microbiology; School of Medicine; University of Adnan Menderes; Aydin; Turkey
| | - Serhan Sakarya
- Department of Infectious Diseases and Clinical Microbiology; School of Medicine; University of Adnan Menderes; Aydin; Turkey
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Abstract
Adult-onset Still's disease (AOSD) is a rare clinical entity with unknown etiology, characterized by arthritis, fever, evanescent rash and other systemic presentations. This report described a 45-year-old male who presented with sore throat, fever, arthritis, evanescent rash, raised liver enzymes and hyperferritinemia. He was diagnosed to have AOSD based on Yamuguchi criteria after the exclusion of other potential diagnoses. The patient partially responded to combined celecoxib and prednisolone. He was also prescribed methotrexate and his symptoms improved.
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Affiliation(s)
- Ong Ping Seung
- Department of Rheumatology, Hospital Raja Permaisuri Bainun, Malaysia
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17
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Retrospective study of 61 patients with adult-onset Still’s disease admitted with fever of unknown origin in China. Clin Rheumatol 2011; 31:175-81. [DOI: 10.1007/s10067-011-1798-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 06/08/2011] [Indexed: 10/18/2022]
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18
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Adult-Onset Still Disease Masqueraded as Sepsis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181d6516b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Abstract
Adult onset Still's disease is a rare, febrile, multisystem rheumatic disease with unknown etiology, which runs an intermittent course and can either go into remission after months to years or progress to a chronic course with substantial joint destruction. The prevalence of this disease has been increasing in the last decade presumably caused by better diagnostic tools but also by a higher awareness among physicians taking care of patients with "fever of unknown origin". This review is intended to augment this trend, since research on the role of proinflammatory cytokines in this disease has led to an improved diagnostic and therapeutic repertoire over the last few years. Ferritin and interleukin-18 serum levels are valuable diagnostic parameters and blockade of interleukin-1, interleukin-6, and tumor-necrosis-factor alpha can effectively control the inflammatory activity of this disease in most cases and also in life-threatening conditions.
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Affiliation(s)
- B Manger
- Medizinische Klinik III, Klinikum der Friedrich-Alexander-Universität, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
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Mehrpoor G, Owlia MB, Soleimani H, Ayatollahi J. Adult-onset Still's disease: a report of 28 cases and review of the literature. Mod Rheumatol 2008; 18:480-5. [PMID: 18754076 DOI: 10.1007/s10165-008-0104-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 04/16/2008] [Indexed: 12/16/2022]
Abstract
Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. It is characterized by fever, skin rash, polyarthralgias or polyarthritis, sore throat, hepatosplenomegaly, lymphadenopathy, leukocytosis, liver enzyme elevation, and high serum level of ferritin. Several kinds of skin lesions have been reported in this condition. The aim of this study was to assess the clinical and laboratory aspects of 28 patients with AOSD in central Iran. According to the diagnostic criteria of AOSD, we identified 28 patients between 2002 and 2007. We intended to describe the clinical characteristics, treatment, and outcome of our patients with AOSD. Of 28 patients with AOSD, 21 (75%) were female, 7 (25%) were male. Fever (100%), sore throat (92%), Arthralgia (92%), dermatographism (92%), typical rash (85%) and arthritis (60%) were the most common findings. The mean values of laboratory findings were as follows; C-reactive protein (CRP) level of 14.4 mg/dl, erythrocyte sedimentation rate (ESR) of 91.5 mm/h, leukocyte count of 15744.4/microl. Abnormal levels of aspartate aminotransferase and alanine aminotransferase were observed in 25 (89%) patients. Twenty patients (71%) had high ferritin values (>500 ng/ml). The clinical characteristics were similar to previous series. A febrile polyarthritis was the most frequent presentation form. Dermatographism was frequently encountered phenomenon in our patients with AOSD. Being that dermatographism is a simple inducible skin reaction, along with its sensitivity in active disease, we suggest more controlled studies to validate accuracy and positive predictive value of it in convenient clinical setting in the diagnosis of AOSD and to consider including it in diagnostic criteria.
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Affiliation(s)
- Golbarg Mehrpoor
- Department of Internal Medicine, Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Safaeieh, Yazd, Iran.
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