Non Infectious Cavitary Lung Lesions in a Patient with Adult Onset Still’s Disease: A Case Report

Abstract

Acute Onset Still's Disease (AOSD) is a disease of immunologic and hematologic dysfunction, whereby a percentage of cases develop further into Macrophage Activating Syndrome (MAS). This patient is a 35 year old Caucasian male with Acute Onset Still's Disease without MAS was hospitalized for multiple cavitary lung lesions. Lesions included a larger estimated 2.5 cm x 2.5 cm cavitary lesion in the Right Middle Lobe and smaller estimated 1.3 x 1.4 cm and 1.8 x 1.2 cm lesions in the Left Lower Lobe of the lungs. The larger lesion was seen on chest X-ray a further detailed on a chest CT scan, which revealed the remaining two smaller pulmonary lesions. The patient experienced undulating fevers as high as 101°F. The patient was put on isolation and received serial blood cultures, sputum cultures, acid fast stains of sputum, urine cultures, viral film array serology all resulting in negative results. Over seven acid fast bacilli stains of sputum were negative in the setting of multiple cavitary lung lesions with high suspicion of active Tuberculosis. The patient received immediate broad spectrum antibiotic and antifungal intravenous antibiotics without relief in fever or symptoms. The patient received a full body Indium scan and MRI of the brain looking for a source of possible infection and further classification of his disease; both of which were negative. The blood and sputum fungal and bacterial cultures were negative. Serial chest CT and chest X-ray demonstrated slightly smaller cavitary lung lesions with thinner walls. The suspicion of Tuberculosis remained high and a lung biopsy was obtained of the large cavitary lesion in the Left Middle Lobe, which did not demonstrate acid fast staining on three separate samples. This patient was concluded to have noninfectious cavitary lung lesions and discharged home with close follow up. He is the first patient reported with AOSD Disease without MAS hospitalized for undulating fevers and multiple cavitary lung lesions without evidence of Tuberculosis of active infection.