'The eyes see what the mind knows.' Adult-onset Still's disease, a case series and review in a south Asian population.
OBJECTIVE
Adult-onset Still's disease (AOSD) is a rare disease. Very few cases have been reported from the South-Asian region so the aim of this study is to assess the clinical and laboratory aspects of 15 patients with AOSD in a tertiary referral hospital in Karachi.


METHODS
Retrospective data was collected from all patients diagnosed using Yamaguchi criteria for AOSD between January 2004 and December 2010 at Jinnah Medical College Hospital, Karachi.


RESULTS
Data of 15 patients with AOSD were analyzed. Their ages ranged from 17 to 55 years, the male-to-female ratio being 6:1. The most common clinical features were fever and articular symptoms (100%), sore throat (60%), rash (53.3%), weight loss (93.3%), lymphadenopathy (40%) and elevated erythrocyte sedimentation rate (86.7%). All patients had leukocytosis with counts>20,000/mm 3 were seen in 40%. Elevated liver enzymes were present in 80% of the case series and hyperferritinemia in 100% with a mean of 3,962 ng/mL (range 555-13,865). Ambiguity in presentation and lack of serologic markers make diagnosis of AOSD difficult as 40% of patients were receiving empirical anti-tuberculous therapy prior to final diagnosis.


CONCLUSIONS
It is necessary for physicians to have a high index of suspicion for AOSD in patients with high-grade fever, arthralgia and leukocytosis.
Department of Medicine, Jinnah Medical College Hospital, Karachi, Pakistan.
Muhammad
M
Ishaq
Lubna
L
Nazir
Amir
A
Riaz
Syed M
SM
Alam
Muhammad I
MI
Shaikh
D000293:Adolescent; D000328:Adult; D018771:Arthralgia / Q000453:epidemiology* / Q000208:ethnology; D001799:Blood Sedimentation; D015897:Comorbidity; D005260:Female; D005293:Ferritins / Q000097:blood; D005334:Fever / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D007964:Leukocytosis / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D010612:Pharyngitis / Q000453:epidemiology* / Q000208:ethnology; D012189:Retrospective Studies; D016706:Still's Disease, Adult-Onset / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D015431:Weight Loss; D055815:Young Adult
D005293:Ferritins