Diagnosis of Adult Onset Still’s Disease in a Patient Who has recovered from Coronavirus-19

Abstract

Introduction: Adult Still’s disease (ASD) is an uncommon inflammatory disorder characterized by fevers, a salmon-colored rash, and arthritis. Cytokines storm syndrome related to Coronavirus-19 (COVID-19) usually occur in acute period of COVID-19 and can mimic clinical features of ASD. Case report: We present a case of a 27-year-old male who was hospitalized in July 2020 due to fever, sore throat, multiple joint pain, and body rash for 2 weeks. Patient recovered from COVID-19 8 weeks ago but his nasopharyngeal SARS CoV-2 PCR was still positive on current hospitalization. Post COVID-19 cytokines storm syndrome post COVID-19 was suspected but after further assessment and investigations, diagnosis of ASD was established and patient was treated with corticosteroids therapy and had favorable outcome. Conclusion: During COVID-19 pandemic, diagnosis of many other diseases either were delayed or missed. We encourage all clinicians to have a broader differential diagnosis to improve patient care and outcome.

Adult-onset Still's disease after mRNA COVID-19 vaccine

“…There have been two other published cases of AOSD presenting after COVID-19, but none after receiving a COVID-19 vaccine. 3,4 The onset of this patient's symptoms were 5 days following the second dose of the vaccine and persisted for nearly 2•5 weeks before initiation of treatment; this supports the idea that this represented a new onset AOSD rather than a hyper-inflammatory response to vaccination. The extensive work-up ruled out infectious and other inflammatory conditions that mimic AOSD.…”

“…The mechanism by which COVID-19 infection or vaccination could trigger AOSD is unknown. 3,4 There is abundant evidence that severe COVID-19 infection can induce a hyperinflammatory response through activation of the innate immune system and overproduction of proinflammatory cytokines (eg, IL-1, IL-6, IL-18, IFN-γ). 5 Similar to AOSD, IL-1 activation appears to play an important role in the immune activation of primary COVID-19, evidenced by the therapeutic efficacy of selective IL-1 inhibition in treatment of both disease processes.…”

New-onset Adult-onset Still’s disease-like syndrome after ChAdOx1 nCoV-19 vaccination—a case series with review of literature

“…The time difference between the COVID vaccination and AOSD-like presentation was relatively short (days to weeks) in the first two cases; however, it was slightly delayed (3 months) in Case 3. The delayed onset as in Case 3 is also in contrast to the recently reported cases of AOSD-like state following COVID vaccination, which had onset ranging from 5-to 13-day post-vaccination [22][23][24]. Such observations highlight the point that hyperinflammatory state following COVID19 vaccination can be variable in severity from mild to life-threatening disease and can present early (in days/few weeks) or occur as a delayed presentation (up to 3 months).…”

“…The common role of IL-1 and IL-6 in the pathogenesis of AOSD and COVID-19 could explain the close similarities between both diseases. cases reported in the literature on the development of AOSD after COVID-19 infection [ 21 , 22 ]. Apart from the COVID infection, vaccination per se can also cause a new onset AOSD-like syndrome.…”

Case Report: Adult Onset Still’s Disease after vaccination against Covid-19

“…It has been proposed that the interplay between host genetic factors, autoimmune mechanisms, and antigens could trigger AOSD 4,13,14 . There have been some case reports of AOSD following a COVID-19 infection in patients who had recently recovered from the illness 15,16 . However, only one case of AOSD has been reported following vaccination with the mRNA-1273 COVID-19 vaccine (Moderna), and one after ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine 5,6 .…”