Still’s Disease – Unlikely Diagnosis on the Old Age

• Ana Campos Nogueira ^[1] ; Tiago Manuel Fernandes ^[2] ; Ana Costa ^[1]
  1. [1] Hospital Pedro Hispano

     Hospital Pedro Hispano

     Matosinhos, Portugal

     
  2. [2] Centro Hospitalar Gaia – Espinho
• Localización: Galicia Clínica, ISSN 0304-4866, ISSN-e 1989-3922, Vol. 80, Nº. 3 (Junio), 2019, págs. 53-55
• Idioma: inglés
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• Resumen

  • Adult Still’s Disease is a rare systemic inflammatory disease. It is characteristically identified in the young adult, with few cases described in older patients.

    The aetiology and pathogenesis remain unknown. The absence of uniformly accepted diagnostic criteria may contribute to underdiagnosis.

    We present a case of 74 year old patient with fever, polyarthralgia, odynophagia, salmon evanescent rash, elevated inflammatory parameters and serum ferritin. Excluded other diagnostics (infections, neoplasia and other immune diseases), the diagnosis of Adult Still’s Disease was assumed. The clinical and analytical improvements with immunosuppressive therapy, and long follow-up without symptomatology, give strength to the diagnosis.

    We present this case by the rarity of this pathology in this age and to emphasize the need to consider this entity whenever we are studying an fever of unknown origin with this clinical triad (daily spiking high fevers, evanescent rash, arthritis) and biologic triad (hyperferritinaemia, hyperleucocytosis with neutrophilia and abnormal liver function test)