International Journal of Clinical & Medical Images

Introduction: Adult onset Still’s disease is an inflammatory disorder that includes a triad of daily fever, arthritis and rash. This disease was first described by George Still in 1896 [1]. In other words it can be described as, systemic onset juvenile idiopathic arthritis. This still’s disease is most common in paediatric population. This same condition is described as adult onset still’s disease when adult patients who are not fulfilling criteria for classic rheumatoid arthritis, but having presentation similar to children with systemic onset idiopathic juvenile arthritis. This is a rare case report of patient who presented with a different presentation and how we diagnosed the same condition. Case Blog A 52 year old male patient presented to ENT department with complaints of hyperplastic candidiasis of oral cavity.

The patient was given management for candiasis, with oral and local antifungal. Simultaneously rapid ELISA was performed two at an interval of 6 weeks was done and results turned out to be negative. The candidiasis was not getting better even after a treatment of four weeks. After four weeks patient presented with history of arthritis of two weeks duration and fever for past seven days. Then patient was referred to medicine department for further workup. In medicine department routine blood investigations were done. Total count was twenty thousand nine hundred with eighty percent polymorphs. Erythrocyte sedimentation rate was one hundred and sixty seven mm/hour. Blood urea was ninety one, creatinine 3.5 mg/dl. Liver function test was showing normal bilirubin, SGOT 56 IU/L, SGPT 57 IU/L, alkaline phosphatase 149, total protein 5.3 gm/dl, albumin 2.9 gm/dl. Urine routine was found to be normal.

Blood and urine culture and sensitivity revealed no growth. Ultrasound of the abdomen showed hepatospleenomegaly. Blood smear for malarial parasite came negative. HBsAg and anti HCV were non reactive. Chest X ray was within normal limits. to rule out associated macrophage activation syndrome bone marrow biopsy was done and the report showed reactive marrow with microcytic hypochromic RBC morphology.