SHM Converge Scientific Abstract ePoster Gallery-A Rare Presentation of Adult Still's Disease in an African American Male

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This case report describes a rare presentation of Adult-Onset Still’s Disease (AOSD) in a 25-year-old African American man. AOSD is a systemic inflammatory disorder with nonspecific symptoms such as high fevers, sore throat, arthritis, myalgia, and a characteristic transient salmon-pink rash. However, this patient presented with an atypical cutaneous eruption: a migratory pruritic rash that evolved into hyperpigmented lichenoid papules and plaques on the trunk and extremities.<br /><br />He also had intermittent high fevers above 104°F, sore throat, and diffuse symmetric joint pain. Laboratory studies showed marked inflammation, including elevated ESR, CRP, ferritin, leukocytosis, and mild transaminitis. Extensive infectious and rheumatologic workup was largely negative aside from a weakly positive ANA. Imaging revealed reactive cervical lymphadenopathy, and echocardiography excluded endocarditis. Skin biopsy showed mild perivascular inflammation and dyskeratotic cells. Based on Yamaguchi criteria, he was diagnosed with AOSD and treated with indomethacin, with close outpatient follow-up.<br /><br />The discussion emphasizes that AOSD is difficult to diagnose because it lacks specific serologic markers and often mimics infection or autoimmune disease. While the classic rash is well known, atypical skin findings such as hyperpigmented plaques and urticarial eruptions have been reported, particularly in Black patients. Recognizing these variants is important to avoid diagnostic delay and initiate treatment early.<br /><br />The report concludes that clinicians should consider AOSD even when skin manifestations are atypical, especially in African American patients with fever, arthralgia, and high inflammatory markers.

Asset Subtitle

Vincent Courant

Meta Tag

Author List Murilo Silva, Salvador Caceros, Vincent Courant

Category Clinical Vignettes

Concept Adult-onset Stills disease

Concept Systemic Inflammatory Symptoms

Concept Yamaguchi criteria

Concept Cutaneous Manifestation

Concept Salmon-Pink Rash

Distinguished Non-Finalist

Presenter Organization Mount Sinai Morningside

Presenting Author Vincent Courant

Track Adult

Keywords

Adult-Onset Still’s Disease

AOSD

atypical rash

hyperpigmented lichenoid plaques

fever

arthralgia

elevated ferritin

Yamaguchi criteria

African American patient

systemic inflammation

Adult-onset Stills disease

Systemic Inflammatory Symptoms

Yamaguchi criteria

Cutaneous Manifestation

Salmon-Pink Rash