A 22-YEAR-OLD MAN WITH LYMPH NODE TUBERCULOSIS AND ADULT ONSET STILL’S DISEASE: A RARE CASE REPORT

Received 2023-08-27; Accepted 2024-01-06; Published 2024-08-01

Abstract

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory sickness with an unknown cause that is marked by a spiking fever that frequently exceeds 39o Celsius, evanescent skin symptoms, arthralgia or arthritis, and multiorgan involvement. Many diseases, such as infections, neoplasia, or immune diseases, can mimic AOSD. We found a rare condition lymph node tuberculosis (TB) with AOSD reported from Indonesia. A 22-year-old man had a prolonged fever, joint pain, reddish rash on extremities, and yellow eye membranes one week after taking a fixed combination anti-tuberculosis drug. The patient had a history of TB cervical lymphadenitis. Clinical examination disclosed salmon-colored rash, arthritis on wrists and shoulder, icterus, and hepatosplenomegaly. Laboratory results also revealed elevated leukocyte, bilirubin, c-reactive protein (CRP), and ferritin levels. Abdominal ultrasound found no cholestasis or obstruction. Immunological examinations showed negative antinuclear antibody (ANA), antibody streptolysin O (ASTO), rheumatoid factor, and hepatitis infection. According to Yamaguchi criteria, this patient fits the diagnosis of AOSD. Oral colchicine was also given with corticosteroids and cyclosporine. The treatment improved the patient’s conditions, with normalization of leukocyte, ferritin, and CRP count. The dose of prednisolone was successfully tapered, and remission was achieved in 2 months after oral administration of colchicine. This case highlights the importance of consideration of AOSD as a potential diagnosis in the presence of abnormal liver function tests and that one should not be misled into a diagnosis of drug-induced liver injury (DILI). Colchicine treatment silenced the disease activity of AOSD.