Fever at Emergncy Service; Adult Onset Still’s Disease

Kıratlı K., Çevik E.

4th Eurasian Congress on Emergency Medicine, Antalya, Türkiye, 13 - 16 Kasım 2014, ss.299-300, (Özet Bildiri)

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: Antalya
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.299-300
  • Dokuz Eylül Üniversitesi Adresli: Evet

Özet

Introduction: Adult onset Still’s disease (AOSD) is a rare systemic inflammatory disorder with a typical evanescent salmon-pink nonpruritic maculopapular rash, leukocytosis (≥10,000 WBC/mm3) with at least 80% neutrophils, fever, and arthralgias/arthritis. We present a case of AOSD who was admitted to our emergency department. Case: A 20-year-old male applied with fever, sore throat, arthralgia, weakness for a period of a month. Weight loss and left knee joint swelling has been added last ten days. There was a past medication history which was given another hospital a month ago. On examination, he was slightly lethargic and was noted to have fever of 39.5°C, left knee swelling, diffuse arthralgia and cervical lymphadenopathy. Abdominal examination showed hepatomegaly. The patient was admitted to infectious disease clinic with diagnosis fever of unknown origin. Complete blood count showed leucocyte count of 15.7 × 103/μL (%89 gran.), hemoglobin 10.8 gm/d and sedimentation rate was 55 mm/h. Other laboratory data showed mildly elevated transaminases (AST: 51 U/L, ALT: 106 U/L) and markedly elevated ferritin levels (1284 ng/mL). Ultrasound of the abdomen showed hepatomegaly (195 mm). After extensive work up including negative rheumatoid factor, negative antinuclear antibody, negative CRP, negative HIV and other acute viral illness, patient was diagnosed with AOSD based on Yamaguchi diagnostic criteria. He had met three major and four minor criteria. Indometacin (3x50 mg) and lansoprasole treatment was started. After 3 days of treatment his complaints began to drop back and liver enzymes began to trend down. He was discharged in a stable condition with normal liver function tests after 22 days of hospitalization. Conclusion: Clinical course of AOSD is usually benign. Rarely, serious complications such as acute liver failure, macrophage activation syndrome/hemophagocytic syndrome, pericarditis, cardiac tamponade, disseminated intravascular coagulation, serous peritonitis, pleuritis, and respiratory failure are seen. AOSD, though a rare entity, must be kept into consideration in unclear cases occurring in an emergency medicine department.