J Rheum Dis.  2011 Jun;18(2):142-146.

A Case of Adult-onset Still's Disease in a Patient with Ankylosing Spondylitis Complicated with Crohn's Disease

• Kim YJ
• Park HS
• Kim SJ
• Kim SS
• Kim YG
• Lee CK
• Yoo B

Abstract

Adult-onset Still's disease (AOSD) is an inflammatory disorder of unknown aetiology characterized by a variety of clinical symptoms. AOSD can precede or occur concomitantly with AS and only a few cases of AOSD with AS have been reported. A 21-year-old man presented with spiking fever, sore throat, arthralgia, maculopapular rash, lymphadenopathy, and chronic inflammatory back pain. His laboratory findings showed marked elevations of liver enzyme, C-reactive protein, erythrocyte sedimentatioin rate, ferritin, and sacroiliitis (grade 2), which were the main characteristics of AOSD and AS. Most symptoms except chronic low back pain were improved after treatment with corticosteroid and disease modifying anti-rheumatic drugs. He was then treated with anti-tumor necrosis factor-alpha (anti-TNF-alpha) agents to control the disease activity of AS and subsequently showed clinical and serological improvement. This is a first case report of AOSD combined with AS in Korea.

Keyword

Adult-onset Still's disease; Ankylosing spondylitis; Sacroiliitis; Crohn's disease

MeSH Terms

Antirheumatic Agents
Arthralgia
Back Pain
C-Reactive Protein
Crohn Disease
Erythrocytes
Exanthema
Ferritins
Fever
Humans
Korea
Liver
Low Back Pain
Lymphatic Diseases
Necrosis
Pharyngitis
Sacroiliitis
Spondylitis, Ankylosing
Still's Disease, Adult-Onset
Young Adult
Antirheumatic Agents
C-Reactive Protein
Ferritins

Figure

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  Figure 1. The patient's lower extremity showed petechia like skin rash.

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  Figure 2. (A) Anteroposterior radiograph of the pelvis shows the erosive change and subchondral sclerosis of the bilateral sacroiliac (SI) joints, which is compatible with bilateral sacroiliitis, grade 2. (B) The sacrum CT revealed irregularity of the articular surface of the left SI joint with possible erosions and pseudo-widening of the right SI joint space, and all this is compatible with sacroiliitis.

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  Figure 3. Colonoscopic findings show diffuse wall thickening and multiple polypoid erythematous elevations with aphthous ulcerations at terminal ileum.

Reference

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