Adult onset still's disease presenting as recurrent fever with ARDS: A case report

Abstract

Adult onset Still's disease (AOSD) is a rare inflammatory disorder characterized by daily spiking fevers, arthritis and an evanescent rash, typically affecting young adults. We report a case of AOSD complicated by acute respiratory distress syndrome (ARDS). This uncommon presentation of AOSD has been infrequently described in literature.A 33 year old Hispanic male presented with recurrent daily fevers, sore throat and lymphadenopathy. Diagnostic evaluation including lymph node biopsy was negative for infectious causes. His clinical course was complicated by acute respiratory distress syndrome. AOSD was diagnosed based on clinical and laboratory findings. Patient was started on steroids and responded well with resolution of his respiratory failure and fever.AOSD is a rare febrile disorder primarily affecting young patients with varied presentations. Diagnosis is clinical and could be easily missed unless the evaluating physician is aware of both the typical as well as atypical presentations such as ARDS, as was found in our patient. Delayed diagnosis or misdiagnosis may lead to recurrent and prolonged hospitalizations in addition to costly and potentially harmful diagnostic workup and therapeutic interventions.