title: Adult Onset Still's Disease Associated withMycoplasma pneumoniaeInfection and Hemophagocytic Lymphohistiocytosis.
abstract: Adult Onset Still's Disease (AOSD) is a systemic inflammatory disorder that can be associated with hemophagocytic lymphohistiocytosis (HLH), a rare but potentially fatal disease of overactive histiocytes and lymphocytes. We present a unique case of AOSD complicated byMycoplasma pneumoniainfection and HLH. A 28-year-old female developed joint pains followed by a diffuse, erythematous, pruritic skin rash that quickly spread throughout the body. The patient deteriorated and developed fever, chills, cough, and dyspnea and had to be intubated. She had hypoalbuminemia, elevated liver enzymes, a very high serum ferritin level, positive anti-Mycoplasma pneumoniaIgG and IgM antibodies, and normal rheumatoid factor and anti-nuclear antibodies. The chest X-ray showed diffuse bilateral infiltrates. Bone marrow biopsy revealed hemophagocytosis. The patient was treated with azithromycin, methylprednisolone, and anakinra and was discharged home on cyclosporine and prednisone. This case highlights that patients can develop features of both AOSD and HLH at the beginning of the disease and early diagnosis and treatment increase the likelihood of recovery.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Agnihotri
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Ruff
authors.affiliation: Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Gotterer
authors.affiliation: Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Addie
authors.initials: A
authors.lastname: Walker
authors.affiliation: Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Amy H
authors.initials: AH
authors.lastname: McKenney
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Andrei
authors.identifier: 0000-0003-1339-3934
authors.initials: A
authors.lastname: Brateanu