SHM Converge Scientific Abstract ePoster Gallery-Unveiling the Enigma: A Case of Adult-Onset Still's Disease With Atypical Features

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A 30-year-old man with prediabetes and vitamin D deficiency presented with two weeks of fever, watery diarrhea, sore throat, left shoulder pain, and bilateral ankle/knee arthralgias. On exam, he was febrile and tachycardic, with limited left shoulder motion, shin tenderness, and decreased breath sounds on the left. Labs showed marked neutrophilic leukocytosis, very high inflammatory markers (ESR, CRP, ferritin), mild lactic acidosis, elevated procalcitonin, and increased CPK. Respiratory testing detected enterovirus/rhinovirus, and chest CT revealed large bilateral pleural effusions with minimal abdominal free fluid.<br /><br />An extensive infectious and autoimmune workup was performed. Blood cultures, CMV, Leptospira, and QuantiFERON testing were negative. Autoimmune studies were largely negative, though weak/borderline autoantibodies were noted, including anti-SSA and anti-CCP. Thoracentesis showed an exudative pleural effusion with negative cultures, supporting a noninfectious inflammatory process. Empiric antibiotics were started initially but discontinued after infection was excluded.<br /><br />The patient was diagnosed with adult-onset Still’s disease (AOSD) based on Yamaguchi criteria, despite atypical features and no classic overlapping rheumatologic disease. He improved after treatment with naproxen and prednisone, with resolution of symptoms.<br /><br />The report emphasizes that AOSD can present diagnostically challenging atypical features, including pleural effusions and weakly positive autoantibodies, and underscores the importance of thorough differential evaluation before confirming the diagnosis.

Asset Subtitle

Arailym Kamzabek

Meta Tag

Author List Arailym Kamzabek, Areej Shahzad, Daniel Echeverria, Erick Phocco Nunez, Irvianny Madera, Jenniffer Ortega Morales, Juan Pablo Moreno Graterol, Munazza Afzal, Mushhood Memon, Nida Rit, Oshna Pandey, Patxis Taveras, Salomon Chamay, Vitaly Adler

Category Clinical Vignettes

Concept Adult-onset Stills disease

Concept Yamaguchi criteria

Concept Clinical Feature

Concept Inflammatory Markers

Concept Neutrophilic Leukocytosis

Distinguished Non-Finalist

Presenter Organization St. Barnabas Hospital, Bronx, NY

Presenting Author Arailym Kamzabek

Track Adult

Keywords

adult-onset Still's disease

AOSD

fever

pleural effusion

neutrophilic leukocytosis

arthralgia

prednisone

naproxen

Yamaguchi criteria

inflammatory markers

Adult-onset Stills disease

Yamaguchi criteria

Clinical Feature

Inflammatory Markers

Neutrophilic Leukocytosis