Arash Mollaeian1, Jingjing Chen2, Nina N Chan2, Gregory A Nizialek2,3, Christopher J Haas2,3. 1. MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA. arash.mollaeian@medstar.net. 2. MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA. 3. Georgetown University School of Medicine, Washington, DC, USA.
Abstract
BACKGROUND: Adult onset Still's disease (AOSD) is a rare inflammatory disorder that classically presents with high spiking fevers, evanescent rash, and arthritis. The diagnosis is one of exclusion and can be further complicated by atypical presentations, particularly in elderly patients in whom AOSD is very rare. CASE PRESENTATION: A case of AOSD in a 73-year-old woman with a non-classic presentation, leading to delayed diagnosis and management, is presented along with a review of the English literature for AOSD cases in elderly people over 70 years of age. Thirty nine case reports and series were identified and the current case was added, totaling 42 individual cases. Significant findings included a four-times higher prevalence in females, a higher prevalence of macrophage activation syndrome despite lower mortality, the presence of pruritic rash in almost one fifth of the cases, and high prevalence of delayed diagnosis. CONCLUSIONS: AOSD in the elderly may vary from the classic criteria described in the medical literature and may lead to delayed diagnosis and management. Further evaluation and better characterization of AOSD in the elderly remains an area of interest.
BACKGROUND: Adult onset Still's disease (AOSD) is a rare inflammatory disorder that classically presents with high spiking fevers, evanescent rash, and arthritis. The diagnosis is one of exclusion and can be further complicated by atypical presentations, particularly in elderly patients in whom AOSD is very rare. CASE PRESENTATION: A case of AOSD in a 73-year-old woman with a non-classic presentation, leading to delayed diagnosis and management, is presented along with a review of the English literature for AOSD cases in elderly people over 70 years of age. Thirty nine case reports and series were identified and the current case was added, totaling 42 individual cases. Significant findings included a four-times higher prevalence in females, a higher prevalence of macrophage activation syndrome despite lower mortality, the presence of pruritic rash in almost one fifth of the cases, and high prevalence of delayed diagnosis. CONCLUSIONS: AOSD in the elderly may vary from the classic criteria described in the medical literature and may lead to delayed diagnosis and management. Further evaluation and better characterization of AOSD in the elderly remains an area of interest.
Authors: A Takami; S Nakao; H Miyamori; M Ooi; T Machi; T Chujo; T Nakazawa; Y Saito; M Kanno; T Matsuda Journal: Intern Med Date: 1995-02 Impact factor: 1.271