IS STILLS DISEASE STILL HARD TO DIAGNOSE? - A RARE ENTITY (CASE REPORT)

Dr. Apoorva Dhiman*, Dr. Keshav Nagpal and Dr. Abhishek Thakur

ABSTRACT

We present here a 31 years FA, Para 3, who presented with fever, sore throat, polyarthritis and pinkish maculopapular evanescent rash for last 4 weeks. Patient was diagnosed as pyrexia of unknown origin in a tertiary care hospital in HP and referred to IGMC on empirical Anti tubercular treatment (ATT) and multiple higher order antibiotics. Work up for underlying infection, malignancy and connective tissue disease was inconclusive. Empirical antibiotics and Anti tubercular therapy at peripheral centre did not relieve symptoms. Laboratory analysis showed anaemia, neutrophilia predominant leukocytosis, transaminitis, hypertriglyceridemia and disproportionately high serum ferritin. Bone marrow biopsy showed haemophagocytosis raising suspicion towards Still’s disease. Skin biopsy was consistent with Adult onset Still’s disease (AOSD). There was dramatic response to NSAIDs and Steroids, while Methotrexate was used as steroid sparing agent. AOSD, although uncommon, presents with characterstic clinical and biochemical features in the differential diagnosis of PUO, high index of suspicion is required to diagnose this disease.

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