Bilateral empyema caused by adult-onset Still's disease.
Empyemas are usually of infectious origin. Noninfectious causes of empyema may be a considerable diagnostic challenge, as exemplified in the present case report. A 21-year-old male presented with high fever, sore throat and myalgias of 1 week duration. In the following days, bilateral pleural effusions developed, with cellular counts in the pleural fluid up to 117 x 10(9)/liter (98% neutrophils). Despite institution of empiric antibiotic therapy, spiking fever continued. All culture studies resulted in being negative. Following the report of a serum ferritin concentration of 6,975 microg/l, adult-onset Still's disease was diagnosed and successfully treated with anti-inflammatory drugs. This case adds adult-onset Still's disease to the list of noninfectious causes of empyema and underlies the value of measuring serum ferritin as a diagnostic tool.
Clinica di Medicina Interna, DPMSC, Università degli Studi, Udine, Italy.
M
M
Mattiuzzo
M
M
Del Forno
B
B
Branca
V
V
Moretti
M
M
Pirisi
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D005293:Ferritins / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D016706:Still's Disease, Adult-Onset / Q000150:complications* / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005293:Ferritins; D011241:Prednisone; D008727:Methotrexate