Interstitial pneumonitis detected by bronchoalveolar lavage and transbronchial lung biopsy in adult-onset Still's disease
A 44-year-old woman was admitted to our hospital because of a high fever that had continued for three weeks. She complained of a sore throat and arthralgia, and had a salmon-pink rash, lymphadenopathy, liver dys-function, and hyperferritinemia. Tests for RF and ANA were negative. Adult-onset Still's disease was diagnosed. Despite administration of steroids, pericarditis, interstitial pneumonitis, and disseminated interavascular coagulation developed. After cyclophosphamide was given, the patient's condition improved, but reticular shadows and volume loss remained on the chest X-ray film. A chest CT scan showed ground-glass-like opacities and linear shadows, and irregular bronchovascular bundles. Bronchoalveolar lavage and transbronchial lung biopsy were done. Alveolar macrophages accounted for 71% of the cells in the bronchoalveolar lavage fluid, and lymphocytes (CD 4/ CD 8 ratio = 1.01) accounted for 29%. Examination of a specimen obtained by transbronchial lung biopsy showed thickened alveolar walls and infiltration of lymphocytes. Reports of cases of adult-onset Stills disease that include results of bronchoalveolar lavage and transbronchial lung biopsy are rare.