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Adult-onset Still's disease evolving with multiple organ failure: Adult-onset Still's disease AOSD is a disorder similar to systemic onset juvenile idiopathic arthritis Still's disease , affecting young adults worldwide.
A year-old white woman with a 3-month fever and weight loss history presented to our hospital. She had symmetric arthritis of hands, facial and thoracic skin rash, high morning fever, nausea, myalgia, and sore throat. The hemoglobin level was Autoimmune and infective serological tests eg, viral hepatitis tests, anti-immunodeficiency virus antibody, antinuclear antibody rheumatoid factor and mononuclesosis antibodies were negative; urinalysis and chest X-ray were normal.
Staphylococcus aureus was present in 1 of 5 samples of blood cultures, and oxacyllin plus gentamicin therapy was started, but a transesophageal echocardiogram showed no vegetations. Abdominal computed tomography revealed nothing but splenomegaly. After an initial improvement, the high fever and skin rash returned, and cervical lymphadenopathy was detected. Lymph node, bone marrow, and rash cutaneous biopsies were performed. Multiple organ failure cardiovascular, pulmonary, renal, and hematologic motivated intensive care unit admission, where management of septic shock, including hydrocortisone, succeeded.
Lymph node biopsy revealed chronic inflammatory infiltrate. A bone marrow specimen showed diffuse hypercellularity. The tuberculin test reading was impaired due to rash.
The patient gradually improved and was discharged asymptomatic from the hospital with oral prednisone after completing antibiotic treatment. In outpatient follow-up, slow tapering of prednisone is in course without evidence of recurrence. Adult-onset Still's disease was first described by Bywaters in By the installation of multiple organ failure, the diagnosis had not yet been confirmed. Large spectrum antibiotics were mandatory, since for diagnosis of AOSD, a fever not related to infection is always one criterion of inclusion.