Adult onset Still's disease: Role of scintigraphy
A 21-year-old female patient presented with fever of high grade, recurrent and intermittent in character, associated with severe sore throat. She was extensively investigated for possible infectious disease. She received antibiotics and antimalarial drugs without any response. Physical examination revealed pallor, hepatomegaly. Investigations revealed hemoglobin of 9.7 g/dL, polymorphonuclear leukocytosis total leukocyte count (TLC 17500/mm3 with 92% neutrophils), thrombocytosis (platelet count 848000/mm3), a markedly raised erythrocyte sedimentation rate (ESR) (45 mm in the 1st hr by Westergren method), negative anti-nuclear antibodies (ANAs), and rheumatoid factor (RF). Serum Ferritin levels were high >13,000 ng/ml. Computed tomography thorax was normal. X-ray of the hands was within normal limit. Liver function tests revealed serum total bilirubin 0.8 mg/dL, serum direct bilirubin 0.45 mg/dL, Serum glutamic pyruvic transaminase/ Alanine transaminase (SGPT/ALT) 31.5 IU/L.\nIn view of the presence of characteristic fever, sore throat, polyarthritis, markedly raised ESR, leukocytosis, and the absence of ANAs and RF, diagnosis of (AOSD) was made.[] She was treated successfully with Prednisone (20 mg).\nTc99m-phytate liver scan [] and Tc99m-Methylene diphosphonate (MDP) bone scan [] were done for assessment of liver parenchymal function and arthritis respectively. Liver scan helped the physicians by making early diagnosis of onset of liver parenchymal dysfunction. Bone scan revealed polyarthritis with involvement of shoulder and hip joints indicating poor prognosis helping physicians to consider for aggressive management. Both the scans demonstrated their utility in early diagnosis of liver parenchymal dysfunction and arthritis pattern, prognostication of arthritis, and management respectively. The painful joints distinctly demonstrated increased uptake of 99mTc-MDP in scintigraphy.