A Case of Adult-Onset Still's Disease Presenting with Urticated Plaques and Acute Myopericarditis
A 23-year-old male was admitted for acute viral myopericarditis with heart failure in which he presented with chest pain associated with dyspnoea, persistent spiking fever with temperature more than 39°C, sore throat, productive cough, and arthralgia. In addition, he developed transient non-pruritic rashes over the neck, axillae, and limbs. Clinical examination revealed a febrile patient who was in heart failure. He had cervical lymphadenopathy, hepatosplenomegaly, and non-scaly orange red plaques and papules over the neck, axillae, and limbs [Figures and ].\nLaboratory investigations revealed raised cardiac enzymes, positive Troponin I, ECG changes consistent with pericarditis, marked leucocytosis with neutrophil predominance, hyperferritinemia, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The rheumatoid factor (RF), anti-nuclear antibody (ANA), and anti-dsDNA were negative. Blood and urine cultures were also negative. Histopathological examination of the skin biopsy revealed features of a neutrophilic dermatosis []. He was diagnosed with AOSD as he had four major and three minor criteria for this entity according to the Yamaguchi's criteria [].\nHe was treated with steroids, diclofenac and azathioprine, which controlled the rash and improved the arthralgia. Subsequently, the patient was out of heart failure and myopericarditis resolved.