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Adult-onset Still’s disease after environmental exposure while working in Africa
  1. Emily L Gilbert and
  2. Benjamin Wang
  1. Rheumatology, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
  1. Correspondence to Dr Emily L Gilbert; gilbert.emily{at}


Adult-onset Still’s disease (AOSD) is characterised by a constellation of systemic inflammatory symptoms and typical laboratory findings like hyperferritinaemia. A high index of suspicion is needed to identify patients as diagnosis is primarily clinical and significant morbidity can result from delayed diagnosis. While AOSD may be self-limited, some patients experience flares over years and require more aggressive treatment approaches. Aetiology is unknown but can be triggered by viral infections and other environmental factors in a susceptible genetic host. We present a case of AOSD triggered after exposure to a sap-like liquid while working in Africa. This inciting event occurred as part of a hostile act towards the patient and involved medicinal practices traditional to the area. Our case highlights the more chronic course of AOSD, which requires escalating biological treatment to avoid long-term corticosteroids, as well as the juncture between traditional and modern medical practices.

  • rheumatology
  • musculoskeletal syndromes
  • medical management
  • global health

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  • Contributors Both ELG and BW saw the presented case together in consultation and formulated the treatment plan. The manuscript was written by ELG with BW providing critical revision.

  • 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.

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