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Case report
Adult-onset Still’s disease in a 73-year-old Maltese man
  1. Janice Borg1,
  2. Mary Louise Camilleri2 and
  3. Paul John Cassar2
  1. 1Department of Medicine, Mater Dei Hospital, Msida, Malta
  2. 2Department of Rheumatology, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Janice Borg; janice.c.borg{at}


Adult-onset Still’s disease (AOSD) is a rare autoinflammatory condition diagnosed by Yamaguchi criteria. We report an atypical presentation of a 73-year-old man, who was admitted with fever, sore throat and pleurisy that were unresponsive to three courses of antibiotics. Fever persisted in a quotidian pattern and the typical salmon-coloured rash consistent with AOSD appeared at 4 weeks from symptoms onset. These features in addition to neutrophilia and hyperferritinaemia in the absence of concurrent infectious and neoplastic causes satisfied Yamaguchi criteria for a diagnosis of AOSD. Epstein-Barr antigen was initially detected at moderate titre levels, but was undetectable after 1 week. Complete resolution of symptoms was reported on initiation of steroid treatment. A relationship between disease onset and viral syndromes has been documented to occur and few similar cases preceded by Epstein-Barr virus detection have been reported.

  • rheumatology
  • medical education
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  • Contributors All authors contributed to the care of the patient and the planning and reporting of the work. JB wrote the case report and carried out the preparation and the write up for the discussion. MLC critically appraised the case report and was also involved in the literature review. PJC was the patient’s caring consultant who also reviewed the case report prior to publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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