An adult onset Still’s disease mimicking pneumonia

Abstract

Adult onset Still's disease is a rare systemic inflammatory disease of unknown origin. It is common to involve liver and spleen, and less often lungs. A 24-year-old man presenting with spiking fever, pulmonary infiltrations, and pleural effusion on the right side mimicking pneumonia. All serologic tests of infectious causes, antinuclear antibody, and rheumatoid factor were negative. He was diagnosed as Adult onset Still's disease according to the criteria of Yamaguchi. Adult onset Still's disease is considering in the differential diagnosis pneumonia that is unresponsive to antimicrobial treatment, negative cultures and serologically diagnostic laboratory tests, and high-level serum ferritin.

Parenchymal lung disease in adult onset Still’s disease: an emergent marker of disease severity—characterisation and predictive factors from Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort of patients

“…In this cohort, 12.25% of patients with AOSD were reported to be affected by LD. This result could suggest a higher rate than reported in available literature [16], but it must be pointed out that mainly isolated case reports investigated this issue [14][15][16], thus limiting the validity of this estimation in adults. Clinically, as observed in SJIA, patients with AOSD-related LD showed a striking dissociation between relatively subtle clinical features, including mild tachypnoea, dyspnoea, chronic cough, and the extension of the inflammatory process in lungs based on chest CT.…”

“…Interestingly, recent evidence from the juvenile counterpart of AOSD, the systemic-onset juvenile idiopathic arthritis (SJIA), suggested the emergent high fatality rate of lung disease (LD) [12,13]. Despite this finding, few studies, mainly isolated case reports, analysed LD in AOSD so far [14][15][16], proposing that nearly 5% of patients with AOSD could be affected by LD, with two main patterns, one characterised by an acute respiratory distress syndrome (ARDS), and one with other LDs, including bronchiolitis and nonspecific interstitial lung diseases [16]. On these bases, given the prognostic role of LD in paediatric patients and the inconclusive evidence in adult ones, we aimed to characterise LD in AOSD and to identify associated clinical features and predictive factors.…”

Adult-Onset Still’s Disease: Still a Serious Health Problem (a Case Report and Literature Review)

“…Our patient had splenomegaly, elevated liver enzymes (AL and AST), and fever as positive signs for RHS but no pancytopenia and neurological symptoms. Other less common manifestations of AOSD include hepatomegaly [ 11 , 32 , 33 ], pneumonia and pleuritis [ 34 ], thrombotic thrombocytopenic purpura (TTP) [ 35 ], and cardiac involvement (pericarditis and tamponade) [ 36 ].…”

A Rare Case of Diffuse Pulmonary Nodules in a Patient with Adult-onset Still's Disease

“…The most common pulmonary manifestations of AOSD are pleural effusion and transient radiological pulmonary infiltrates, which may mimic pneumonia (3,4). Pulmonary arterial hypertension (5, 6), cryptogenic organizing pneumonia (7), and diffuse alveolar hemorrhage (8) have also been described.…”