Posters
A Case of Adult Onset Still's Disease
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Introduction: Adult Onset Still’s disease is a rare inflammatory disease affecting approximately 4 people in 1 million. It is a multi system disease with a common presentation of high fevers, skin rashes, arthritis, and elevated ferritin. Current research states that the cause is unknown but genetic factors may predispose patients to this disease. If left undiagnosed and untreated, it leads to long term and irreversible joint damage along with organ damage.
Description: A 48 year old woman presented to the clinic with complaints of migratory arthritis, generalized malaise, fever, sore throat, generalized pink non itchy rash, and flu like symptoms that have been ongoing for over six weeks. The patient reported that prior to the onset of her symptoms, she had been moving furniture from a wooded area and may have possibly been bitten by a “bug.” In addition to these complaints, the patient had an ongoing history of comorbidities including obesity, and chronic generalized pain categorized as possible fibromyalgia. This patient met the classic presentation of a patient with lyme disease. Along with standard labs, an ELISA & Western blot test to detect antibodies to Borrelia Burgodorferi was ordered and the patient was started on a 14 day course of doxycycline while awaiting results. The patient’s results came back negative. The patient returned to the clinic two weeks later with persistent and worsened symptoms. A battery of tests were ordered to now rule out possible causes of this patient’s presentation including antinuclear antibodies, rheumatoid factor, STI testing, and special attention was paid to CBC, CMP, liver function tests, and inflammatory markers. Everything came out negative with the exception of an elevated ESR, an elevated C-reactive protein, an increased WBC, decreased RBC’s, increased ferritin, and elevated liver enzymes. This clinical picture was extremely puzzling given the negatives. The patient’s case was revisited from the beginning. Careful consideration was made to the timeline of the fever, rash, joint pain, sore throat, past medical history, physical, and lab results. The diagnosis of Still’s disease was reached. This was a diagnosis of exclusion after careful analysis and ruling out.
Conclusion: Adult Onset Still’s disease is considered a rare disease according to the NIH. It begs the question, “Is this a rare disease because it is an immatator of other well known autoimmune conditions thereby going underdiagnosed?” From this patient’s presentation, it was very easy to dismiss this as a myriad of other things. However, careful and thorough examination was undertaken in order to reach this diagnosis of exclusion. The current FDA treatment for this condition is Iliaris, a human anti-IL-1β monoclonal antibody which neutralizes 1β signaling, resulting in suppression of inflammation in patients with disorders of autoimmune origin.
Academic/Professional Position
Medical Student
Academic/Professional Position (Other)
MS3
Recommended Citation
Eyobio, Unyime-Abasi, "A Case of Adult Onset Still's Disease" (2023). Research Symposium. 110.
https://scholarworks.utrgv.edu/somrs/theme1/posters/110
A Case of Adult Onset Still's Disease
Introduction: Adult Onset Still’s disease is a rare inflammatory disease affecting approximately 4 people in 1 million. It is a multi system disease with a common presentation of high fevers, skin rashes, arthritis, and elevated ferritin. Current research states that the cause is unknown but genetic factors may predispose patients to this disease. If left undiagnosed and untreated, it leads to long term and irreversible joint damage along with organ damage.
Description: A 48 year old woman presented to the clinic with complaints of migratory arthritis, generalized malaise, fever, sore throat, generalized pink non itchy rash, and flu like symptoms that have been ongoing for over six weeks. The patient reported that prior to the onset of her symptoms, she had been moving furniture from a wooded area and may have possibly been bitten by a “bug.” In addition to these complaints, the patient had an ongoing history of comorbidities including obesity, and chronic generalized pain categorized as possible fibromyalgia. This patient met the classic presentation of a patient with lyme disease. Along with standard labs, an ELISA & Western blot test to detect antibodies to Borrelia Burgodorferi was ordered and the patient was started on a 14 day course of doxycycline while awaiting results. The patient’s results came back negative. The patient returned to the clinic two weeks later with persistent and worsened symptoms. A battery of tests were ordered to now rule out possible causes of this patient’s presentation including antinuclear antibodies, rheumatoid factor, STI testing, and special attention was paid to CBC, CMP, liver function tests, and inflammatory markers. Everything came out negative with the exception of an elevated ESR, an elevated C-reactive protein, an increased WBC, decreased RBC’s, increased ferritin, and elevated liver enzymes. This clinical picture was extremely puzzling given the negatives. The patient’s case was revisited from the beginning. Careful consideration was made to the timeline of the fever, rash, joint pain, sore throat, past medical history, physical, and lab results. The diagnosis of Still’s disease was reached. This was a diagnosis of exclusion after careful analysis and ruling out.
Conclusion: Adult Onset Still’s disease is considered a rare disease according to the NIH. It begs the question, “Is this a rare disease because it is an immatator of other well known autoimmune conditions thereby going underdiagnosed?” From this patient’s presentation, it was very easy to dismiss this as a myriad of other things. However, careful and thorough examination was undertaken in order to reach this diagnosis of exclusion. The current FDA treatment for this condition is Iliaris, a human anti-IL-1β monoclonal antibody which neutralizes 1β signaling, resulting in suppression of inflammation in patients with disorders of autoimmune origin.