Adult-onset Still's disease possibly consequent to asymptomatic COVID-19
Authors: Paula Ibanez, Angel Manuel Iniesta, Angel Robles, Mariana Gutierrez, Francisco Bermudez, Juan Carlos Martin
Background: In some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease 2019 [COVID-19]), an uncontrolled release of inflammatory cytokines is characteristic. COVID-19 and adult-onset Stills disease (AOSD) have been included by some authors in the hyperferritinemic syndromes. Another hyperinflammatory syndrome (with variable features of Kawasaki disease) called multisystem inflammatory syndrome (MIS) has been described in patients who have had SARS-CoV-2 infection. Case Presentation: We present a previously healthy patient who developed hyperinflammatory reaction compatible with MIS; the clinical presentation is additionally compatible with AOSD, complicated with a mild myocarditis. The patient had a positive SARS-CoV-2 serology (immunoglobulins G and immunoglobulins M ), but multiple reverse transcription-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 on nasopharyngeal swab were negative or indeterminate, so we considered that it is possible that an asymptomatic SARS-CoV-2 infection could have been the trigger for Stills disease. 24 hours after starting methylprednisolone treatment, the fever was resolved and symptoms improved over the next few days, with persistent arthralgias. Conclusion: Asymptomatic SARS-CoV-2 infection could trigger MIS with AOSD-like features.
Keywords: SARS-CoV-2, COVID-19, adult-onset Still’s disease (AOSD), myocarditis, hyperferritinemic syndromes, multisystem inflammatory syndrome (MIS), multisystem inflammatory syndrome of children (MIS-C), case report
Authors
Correspondence to:
Juan Carlos Martín, Servicio de medicina interna, Hospital universitario La Paz, Paseo de la Castellana, n& 8304 jcarlos.martin@salud.madrid.org
Publication history:
Received 14 Feb 2021
Revised 08 Apr 2021
Accepted 26 Jun 2021
Published online 13 Jul 2021
Published in print 25 Jul 2021
Ibanez P, Iniesta AM, Robles A, Gutierrez M, Bermudez F, Martin JC. Adult-onset Still's disease possibly consequent to asymptomatic COVID-19. EJMCR. 2021; 5(7): 218-221. doi:
10.24911/ejmcr/173-1613255228
Ibanez P, Iniesta AM, Robles A, Gutierrez M, Bermudez F, Martin JC. Adult-onset Still's disease possibly consequent to asymptomatic COVID-19. https://www.ejmcr.com/?mno=55795 [Access: April 20, 2024]. doi:
10.24911/ejmcr/173-1613255228
Ibanez P, Iniesta AM, Robles A, Gutierrez M, Bermudez F, Martin JC. Adult-onset Still's disease possibly consequent to asymptomatic COVID-19. EJMCR. 2021; 5(7): 218-221. doi:
10.24911/ejmcr/173-1613255228
Ibanez P, Iniesta AM, Robles A, Gutierrez M, Bermudez F, Martin JC. Adult-onset Still's disease possibly consequent to asymptomatic COVID-19. EJMCR. (2021), [cited April 20, 2024]; 5(7): 218-221. doi:
10.24911/ejmcr/173-1613255228
Ibanez, P., Iniesta, . A. M., Robles, . A., Gutierrez, . M., Bermudez, . F. & Martin, . J. C. (2021) Adult-onset Still's disease possibly consequent to asymptomatic COVID-19. EJMCR, 5 (7), 218-221. doi:
10.24911/ejmcr/173-1613255228
Ibanez, Paula, Angel Manuel Iniesta, Angel Robles, Mariana Gutierrez, Francisco Bermudez, and Juan Carlos Martin. 2021. Adult-onset Still's disease possibly consequent to asymptomatic COVID-19. European Journal of Medical Case Reports, 5 (7), 218-221. doi:
10.24911/ejmcr/173-1613255228
Ibanez, Paula, Angel Manuel Iniesta, Angel Robles, Mariana Gutierrez, Francisco Bermudez, and Juan Carlos Martin. "Adult-onset Still's disease possibly consequent to asymptomatic COVID-19." European Journal of Medical Case Reports 5 (2021), 218-221. doi:
10.24911/ejmcr/173-1613255228
Ibanez, Paula, Angel Manuel Iniesta, Angel Robles, Mariana Gutierrez, Francisco Bermudez, and Juan Carlos Martin. "Adult-onset Still's disease possibly consequent to asymptomatic COVID-19." European Journal of Medical Case Reports 5.7 (2021), 218-221. Print. doi:
10.24911/ejmcr/173-1613255228
Ibanez, P., Iniesta, . A. M., Robles, . A., Gutierrez, . M., Bermudez, . F. & Martin, . J. C. (2021) Adult-onset Still's disease possibly consequent to asymptomatic COVID-19. European Journal of Medical Case Reports, 5 (7), 218-221. doi:
10.24911/ejmcr/173-1613255228