SHM Converge Scientific Abstract ePoster Gallery-A Challenging Case of Fatal Adult-Onset Still's Disease

Pdf Summary

This case describes a 78-year-old woman with altered mental status, high-grade quotidian fevers, night sweats, anorexia, fatigue, and diarrhea. Her evaluation met multiple diagnostic features consistent with adult-onset Still’s disease (AOSD), including double quotidian fevers, an evanescent salmon-pink rash, arthralgias with hepatosplenomegaly, markedly elevated ferritin (1800), and lack of response to multiple antibiotics despite negative infectious and malignancy workup. She showed dramatic improvement in mental status, fever pattern, and laboratory findings after empiric high-dose corticosteroids were started on days 16–26.<br /><br />Her course was later complicated by new atrial fibrillation and a left femoral deep vein thrombosis on day 28. She was started on full-dose enoxaparin, but subsequently developed a concealed psoas hematoma and retroperitoneal hemorrhage leading to hemorrhagic shock.<br /><br />The case highlights that AOSD in elderly patients is uncommon and often overlooked or misdiagnosed, especially when other medical problems coexist. It emphasizes the need to consider AOSD in older patients with persistent unexplained fever that does not respond to broad-spectrum antibiotics and when infectious and malignant causes have been excluded. It also underscores the importance of careful anticoagulation risk assessment in patients with systemic inflammation, prolonged hospitalization, recent corticosteroid use, and other bleeding risk factors, given the potential for fatal hemorrhagic complications.

Asset Subtitle

Yasser Abdelbaki

Meta Tag

Author List Amenah Ibrahim, Yasser Abdelbaki

Category Clinical Vignettes

Concept Adult-onset Stills disease

Concept Quotidian Fever

Concept Evanescent Rash

Concept Persistent Unexplained Fever

Concept Arthralgia

Distinguished Non-Finalist

Presenter Organization Northwell

Presenting Author Yasser Abdelbaki

Track Adult

Keywords

adult-onset Still's disease

elderly patient

altered mental status

high-grade fever

salmon-pink rash

elevated ferritin

corticosteroid response

atrial fibrillation

deep vein thrombosis

retroperitoneal hemorrhage

Adult-onset Stills disease

Quotidian Fever

Evanescent Rash

Persistent Unexplained Fever

Arthralgia