1Noorein Abdulghafoor Omar, 2Sanaa Suleiman Said, 3Clive Kelly

1Mnazi Mmoja Hospital, 2The State University Of Zanzibar, 3James Cook University Hospital, 4University of New Castle upon Tyne

Purpose Statement:

Adult Onset Still’s Disease (AOSD) is a rare systemic auto-inflammatory disease, characterized with persistent high spiking fever, arthralgia, and salmon coloured skin rash (1). However, it can present with pericardial and pleural effusion in over 20% of patients mimicking idiopathic recurrent pericarditis (2). Herein, we present a case of AOSD that presented with recurrent pericardial and pleural effusion with no fever. We aim to raise physicians’ awareness of the multifaceted presentation of AOSD.

Method(s): This is a Clinical Case

Result(s): This is a Clinical Case

Conclusion(s): AOSD was first described by George Still in 1896, and subsequently in 1971 by Bywaters (3). In earlier descriptions, serositis (pericarditis and/or pleuritis) was proposed as a main symptom of AOSD (2). In tropical regions, serositis is often considered a consequence of infection which may delay the correct diagnosis of AOSD. In our case where fever was not a predominant symptom and the rash may not have been visible because of dark skin, the diagnosis was further delayed. Physicians should therefore consider atypical presentations of AOSD that occur in up to 20% of patients, with serositis and other systemic features in the absence of fever. A raised serum ferritin remains a useful diagnostic indicator.

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