Adult onset Still's disease presenting as aseptic meningitis in a young healthy female.

A 20-year-old white female presented with symptoms of upper respiratory tract infection, meningeal signs, rash, and fever. Initial laboratory data revealed a leukocytosis and abnormal CSF. An initial working diagnosis of the Aseptic Meningitis Syndrome was made. She did not respond to antimicrobial therapy. All culture results and viral titers were negative. One week into her hospital course, the diagnosis of Adult Onset Still's Disease (AOSD) was made. Antibiotics were discontinued and nonsteroidal anti-inflammatory drugs (NSAIDS) begun. The patient showed marked improvement within 24 hours. This case reveals that AOSD is an important consideration in the differential diagnosis of Aseptic Meningitis. Meningeal signs and abnormal cerebrospinal fluid (CSF), both detected in this patient, are very rare occurrences in Still's disease.