A 20-Year-Old Man with Sore Throat, Fever, Myalgias, and a Pericardial Effusion

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2021

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Ghalla, Sheena
Hatch, Jonathan

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Background: Adult Onset Still's Disease is rarely diagnosed, yet if missed, can lead to severe consequences. In this scholarly review of a case study, we analyze an article from the New England Journal of Medicine titled, "A 20-Year-Old Man with Sore Throat, Fever, Myalgias, and a Pericardial Effusion." Observations: The patient initially presented with a fever and diffuse myalgia that had progressively gotten worse over the following days. He developed sore throat, shortness of breath, and pain on the left side of his chest. Antibiotics were administered to the patient but showed no relief of symptoms. Eventually, the patient was admitted to the hospital, where he developed faint pink macules on his forearms and lower extremity pitting edema. Diagnosis: While this patient presented with a variety of signs and symptoms, he presented with 7 of the 8 Yamaguchi criteria, often used in diagnosing Adult Onset Still's Disease. These included temperature ≥39°C lasting ≥ 1 week, arthralgias lasting for ≥ 2 weeks, rash, leukocytosis, sore throat, abnormal LFTs, and negative ANAs and RFs. Presence of the Yamaguchi criteria combined with an absence of other disease processes left Adult Onset Still's Disease as the final diagnosis. The patient was treated with burst steroids and IL-1 receptor antagonists for quick resolution. Consequences of Wrong Diagnosis: Diagnosing Adult Onset Still's Disease is crucial to preventing deadly sequelae such as macrophage activation syndrome, disseminated intravascular coagulopathy, thrombotic thrombocytopenic purpura, diffuse alveolar hemorrhage, and pulmonary arterial hypertension.

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