title: A case of paraneoplastic syndrome mimicking adult-onset Still's disease.
abstract: A 49-year-old woman was admitted to our hospital because of fever of unknown origin. The patient had long-lasting spiking fever, hepatosplenomegaly, pleural effusion, and skin rash. Laboratory tests showed marked leukocytosis and an extremely high serum ferritin level (240 000 ng/ml) accompanied by disseminated intravascular coagulation and hemophagocytic syndrome. Most of the patient's features were compatible with a diagnosis of adult-onset Still's disease (AOSD), the rash, however, was not a typical rheumatoid rash but multiforme erythema. Biopsy of a breast nodule revealed breast cancer, leading us to a diagnosis of paraneoplastic syndrome mimicking AOSD. Although this is a rare disorder, cases resembling the present one have been reported, indicating the importance of including paraneoplastic syndrome in the differential diagnosis of AOSD.
authors.affiliation: Department of Medicine and Rheumatology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. y-komano.rheu@tmd.ac.jp
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Komano
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kubota
authors.forename: Shihoko
authors.initials: S
authors.lastname: Wakabayashi
authors.forename: Sae
authors.initials: S
authors.lastname: Ochi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nonomura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hagiyama
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nanki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kohsaka
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka