PUO�Clinicians Dilemma Clinical profile of adult�onset Still’s(AOSD)

Dr. Rajesh Karekar; Dr. Vitthal Pawar

Volume : VI, Issue : X, October - 2016

PUO�Clinicians Dilemma Clinical profile of adult�onset Still’s(AOSD)

Dr. Rajesh Karekar, Dr. Vitthal Pawar

Abstract :

Background: Adult–onset Still’s disease (AOSD) is a rare inflammatory disease of unknown etiology, which commonly affects young adults regarding which sparse published data are available from India. In the present paper, we aimed to describe clinical and laboratory spectrum AOSD patients. Methods: Retrospective study of 7 patients, who presented with pyrexia of unknown origin (PUO) seen over a 3–year period who were diagnosed to have AOSD after a thorough work–up. Results: Their mean age was 28 (range 20–35) years; there were five females. Mean duration of symptoms was 12 week . All patients had spiking fever, 4 patient had arthralgia involving both large and small joints and a negative ANA and RF. Preceding sore throat was noted in 3 cases. Salient laboratory abnormalities were as follows: mean leukocyte count (range 15,800–22,000) /mm3, leukocytosis (n=7), neutrophilia (n=7), anaemia (n=1) hepatic dysfunction (n=3), mean serum ferritin very high (range 10000–40000) ng/mL, (n=7). All cultures were negative for microbial growth. Serositis with minimal pleural fluid collection was noted in 1case. Nuclear scan was done in 2 patients and was S/O acute hepatitis. All patients fulfilled the required Yamaguchi criteria for the diagnosis of AOSD. All patients treated with non–steroidal anti–inflammatory drugs, oral and IV corticosteroids and responded well to treatment. Conclusions: Diagnosis of AOSD is Challenging. Validated diagnostic Yamaguchi criteria and judicious interpretation of serum ferritin in a patient with a compatible clinical presentation can assist in making early and correct diagnosis