Adult-Onset Still Disease Triggered by Recent Cytomegalovirus Infection: A Diagnosis of Exclusion and a Review of the Literature

Authors

• Luisa Montoya, Knapp Medical Center
• Abdel Martinez Borrego, The University of Texas Rio Grande Valley School of MedicineFollow
• Krystal Simono, Knapp Medical Center
• Singh Ripudaman, The University of Texas Rio Grande Valley School of Medicine
• Aramide Tijani, The University of Texas Rio Grande Valley School of MedicineFollow
• Mangina Sunaina, Knapp Medical Center

Document Type

Article

Publication Date

2026

Abstract

Adult-onset Still disease (AOSD) is a rare systemic autoinflammatory disorder characterized by quotidian fever, inflammatory arthritis, evanescent rash, neutrophilic leukocytosis, and hyperferritinemia. Because no pathognomonic diagnostic test exists, diagnosis relies on characteristic clinical features and exclusion of infectious, malignant, and autoimmune disorders. Viral infections, including cytomegalovirus (CMV), have been proposed as potential immunologic triggers in genetically susceptible individuals, although causality remains unproven. We report a 47-year-old Hispanic woman with hypertension and type 2 diabetes mellitus who presented with one week of daily fever, severe diffuse polyarthralgia, sore throat, fatigue, and a persistent erythematous rash that had begun six months earlier. Laboratory evaluation revealed marked neutrophilic leukocytosis (27.3 × 109/L), hyperferritinemia (2,853 ng/mL), elevated erythrocyte sedimentation rate (110 mm/hour), C-reactive protein (26 mg/dL), and procalcitonin (5.84 ng/mL). Extensive infectious evaluation, including blood cultures and testing for HIV, Epstein–Barr virus, tick-borne diseases, sexually transmitted infections, and other pathogens, was negative except for positive CMV IgG and IgM. Comprehensive autoimmune testing, peripheral blood smear, and computed tomography excluded connective tissue disease and hematologic malignancy. After systematic exclusion of alternative diagnoses, the patient fulfilled Yamaguchi criteria for AOSD. Prednisone 40 mg daily resulted in rapid resolution of fever, improvement in arthralgia, and normalization of inflammatory markers. This case highlights the diagnostic complexity of AOSD and suggests that recent CMV infection may act as an immunologic trigger rather than the primary disease process.

Comments

© 2026 American Federation for Medical Research.   This article is distributed under the terms of the Creative Commons Attribution 4.0 License

Recommended Citation

Luisa, M., Abdel, M., Krystal, S., Ripudaman, S., Aramide, T., & Sunaina, M. (2026). Adult-Onset Still Disease Triggered by Recent Cytomegalovirus Infection: A Diagnosis of Exclusion and a Review of the Literature. Journal of Investigative Medicine High Impact Case Reports, 14, 23247096261501834. https://doi.org/10.1177/23247096261501834

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Publication Title

Journal of Investigative Medicine High Impact Case Reports

DOI

10.1177/23247096261501834

Academic Level

resident

Mentor/PI Department

Internal Medicine