Recurring Lower Abdominal Pain and Fever as Initial Presentation of Adult Onset Still’s Disease in the Absence of Arthralgia and Other System Involvement
  • Abuajela Sreh
    Acute Internal Medicine Department, Walsall Manor Hospital, Walsall http://orcid.org/0000-0002-3434-3357
  • Nithyananda Rajaiah
    Acute Internal Medicine Department, Walsall Manor Hospital, Walsall
  • Mohammad Saim
    Acute Internal Medicine Department, Walsall Manor Hospital, Walsall

Keywords

Adult Onset Still’s Disease, AOSD, fever of unknown origin, pyrexia, abdominal pain

Abstract

A 34 year-old Afro-Caribbean female presented with recurring episodes of fever and lower abdominal pain over a period of two months not improving despite courses of antibiotics for possible recurrent urinary tract infections. On admission to hospital, patient was treated for a possible pyelonephritis or pelvic inflammatory disease (PID). Extensive investigations into possible source of infection were carried out. However, all of the repeated microbiological cultures were normal. Patient was investigated further for other possible causes including connective tissue disease, haematological disorders, or neoplasm, all of which were normal. Diagnosis of adult onset Still’s disease (AOSD) was confirmed by a rheumatologist based on Yamaguchi’s diagnostic criteria for AOSD alongside significantly raised serum ferritin. Patient was treated with steroids to which she showed remarkable clinical improvement alongside marked reduction in her serum ferritin levels.

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References

  • Mihaescu R, Serban C, Mozos I, Sirbu E. Adult-onset still's disease presenting as persistent fever of unknown origin: Case report and review of literature. J Banagladesh Coll Phys Surg 2014;32:224-228.
  • Carreño MA, Carvallo A, Trejo C, Ballestero F, Martinez C. Adult Still’s disease. A great simulator: retrospective review of 20 patients. Rev Med Chil 2009;137:1010–1016.
  • Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R et al. Preliminary criteria for classification of adult Still's disease. J Rheumatol 1992;19:424-430.
  • Ha F, Khalil H. Crohn's disease: a clinical update. Therap Adv Gastroenterol 2015;8:352-9. doi: 10.1177/1756283X15592585.
  • Crohn's disease; NICE CKS, April 2015 (UK access only). Available from URL: https://cks.nice.org.uk/crohns-disease
  • Gasche C, Lomer MCE, Cavill I, Weiss G. Iron, anaemia, and inflammatory bowel diseases. Gut 2004;53:1190–1197.
  • Magadur-Joly G, Billaud E, Barrier JH, Pennec YL et al. Epidemiology of adult Still’s disease: estimate of the incidence by a retrospective study in west France. Ann Rheum Dis 1995;54:587–90.
  • Bywaters E. Still’s disease in the adults. Ann Rheum Dis 1971;30:121-133.
  • Dunne CA, Davies J. Epidemiology of adult Still's disease. Ann Rheum Dis 1996;55:272.
  • Shin SH, Shin DH, Ryu PY, Chung SS, Rhee JH. Proinflammatory cytokine profile in Vibrio vulnificus septicemic patients' sera. FEMS Immunol Med Microbiol 2002;33:133-138.
  • Ohta A, Yamaguchi M, Kaneoka H, Nagayoshi T, Hiida M. Adult Still’s disease: review of 228 cases from the literature. J Rheumatol 1987;14:1139–46.
  • Akintayo RO, Adelowo O. Adult-onset Still's disease in a Nigerian woman. BMJ Case Rep 2015. doi:10.1136/bcr-2015-21078.
  • Manger B, Rech J, Schett G. Use of methotrexate in adult-onset Still’s disease. Clin Exp Rheumatol 2010;28 (Suppl. 61):S168-S171.
  • Kokkinos A, Iliopoulos A, Greka P, Efthymiou A, et al. Successful treatment of refractory adult-onset still’s disease with infliximab. A prospective, non-comparative series of four patients. Clin Rheumatol 2004;23:45–49.
  • Husni ME, Maier AL, Mease PJ, Overman SS et al. Etanercept in the treatment of adult patients with Still’s disease. Arthritis Rheum 2002;46:1171–1176.

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    This figure shows the patient’s persistent pyrexia and other vital signs over the first five days of her admission. downloads: 0

    Published: 2017-08-29
    Issue: Vol. 4 No. 6 (view)

    How to cite:
    1.
    Sreh A, Rajaiah N, Saim M. Recurring Lower Abdominal Pain and Fever as Initial Presentation of Adult Onset Still’s Disease in the Absence of Arthralgia and Other System Involvement. EJCRIM 2017;4 doi:10.12890/2017_000619.

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