Skin rash and fever of unknown origin: what could this be?
A 24-year-old lady who presented with a 10-day history of high spiking fever of unknown origin along with sore throat with cervical lymphadenopathy, evanescent maculopapular salmon-coloured skin rash (over her trunk, abdomen, arms, palms and face), myalgia and migratory polyarthritis. She was found to have neutrophilic leucocytosis (13 500/µL leukocytes and 78% of neutrophils), high serum ferritin levels (20643.45 ng/mL), and elevated erythrocyte sedimentation rate (90 mm/ 1st hour) and C-reactive protein (120 mg/L)

She also had abnormal liver function tests hepatosplenomegaly. After extensive workup, potential diagnoses were ruled out and the patient was diagnosed with adult-onset Still’s disease (AOSD) based on the Yamaguchi criteria. The potential diagnoses that have been ruled out were neoplastic diseases (eg, lymphoma), insidious infections (eg tuberculosis or zoonosis) or other immune diseases (such as systemic lupus erythematosus).

She responded well to indomethacin and was discharged home after 72 hours of apyrexia and symptom improvement. She was readmitted five days following discharge with recrudescence of symptoms.

Subsequently, she was started on high dose prednisolone with clinical improvement and discharged home with outpatient follow-up instructions. At the next clinic visit, all her symptoms had subsided completely and her steroid dosage was tapered appropriately.

LEARNING POINTS
• Adult-onset Still’s disease is generally considered as a diagnosis of exclusion, as it presents with a combination of non-specific symptoms.

• Skin manifestations are associated with systemic diseases.

• Persistent febrile syndromes typically occur in young age.

The following case has been reported in European Journal of Case Reports in Internal Medicine.

Read more here: https://pxmd.co/SE6OW
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