ADULT ONSET STILL'S DISEASE WITH PLEUROPERICARDITIS

Abstract

We present a case of adult onset Still's disease (AOSD) revealed by pleuropericarditis. A 33 yr old man was admitted with fever, fatigue, chest and back pain. Radiological and laboratory investigations showed pleuropericarditis with leucocytosis, anemia, high erthyrocyte sedimentation rate and serum C-reactive protein level. Pleural fluid consisted predominantly of lymphocytes. Cytological and microbiological analysis were inconclusive and empiric antituberculous therapy with methylprednisolone was started. The symptoms improved. When steroid doses were reduced, clinical and laboratory findings worsened. Thoracoscopic pleural biopsy was obtained and it showed chronic fibrinous pleuropericarditis. Hepatosplenomegaly and history of arthralgia, high ferritin levels, negative ANA, RF, were consistent with AOSD. Antituberculosis therapy was stopped. Methotrexate was started. Since the diagnosis of AOSD requires the exclusion of specific etiologies of pleuropericarditis, it may be defined with some delay in time.