Adult-onset Still's disease in a 73-year-old Maltese man

Sore Throat to Still's: Group A Streptococcus Causing Adult-Onset Still's Disease

Adult-onset Still's disease (AOSD) is a rare hyper-inflammatory disease with poorly understood etiology, often presenting with nonspecific symptoms such as fever, inflammatory polyarthralgia, transient salmon-pink maculopapular rash, lymphadenopathy, and hepatosplenomegaly. We are presenting an unusual case of AOSD triggered by Group A streptococci (GAS) throat infection. We report the case of a 37-year-old male with no significant medical history admitted to medicine service after three emergency room (ER) visits. Our patient had a confirmed GAS throat infection and initially met the Jones criteria. However, further testing revealed significantly high inflammatory markers, clinically evident symmetrical synovitis in wrists and left knee, and widespread lymphadenopathy with worsening maculopapular rash. Given this, he met the Yamaguchi criteria, resulting in a diagnosis of AOSD. Group A Streptococcus infections are usually linked to acute rheumatic fever (ARF), but in our case, we believe GAS infection triggered the cascade of inflammatory responses resulting in AOSD. The patient received treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and high-dose steroids with a resolution of arthralgia, down-trending ferritin, and clinical improvement in a skin rash. To the best of our knowledge, we are reporting the first case of GAS-triggered AOSD, highlighting the need to uncover atypical causes for AOSD and warranting the need to investigate triggers for AOSD.

Serosal Involvement in Adult-Onset Still's Disease: A Multicenter and Retrospective Study

BACKGROUND

This study evaluated the characteristics of serosal involvement in Adult-onset Still's disease.

METHODS

Patients meeting the Yamaguchi classification criteria were classified into AOSD with and without serosal involvement according to their manifestations and sonography/radiography. Clinical data were retrospectively reviewed from 102 AOSD patients of two centers.

RESULTS

Forty-two patients (41.2%) had serosal involvement. The frequencies of pulmonary infiltrate and impaired liver function were significantly higher in patients with serosal involvement (P=0.002 and P=0.007, respectively), who also had a higher modified systemic score (P=0.009). In addition, the percentages of CD3+ T cells (P<0.0001) and, especially, the CD8+ T cells (P=0.004) were significantly increased in the peripheral blood of AOSD patients with serosal involvement. Notably, patients with serosal involvement were more likely to develop MAS (P=0.047) and develop into chronic pattern (P=0.016) during the follow-up.

CONCLUSION

Patients with serosal involvement demonstrated the more severe disease activity and different immune phenotypes, and these patients were more likely to develop MAS, and they may require more aggressive treatment at an early time to control their systemic inflammation.

Elderly-onset adult Still's disease

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.