Case Report: Persistent Pruritic Plaques in Adult-Onset Still’s Disease

These reports and our reported case suggest that a heightened clinical index of suspicion for malignancy is warranted in patients presenting with signs and symptoms resembling AOSD. Several red flags have been reported to be associated with malignancy in AOSD, including older age, atypical rash, extremely high levels of LDH, atypical cells in the differential blood count and high levels of the soluble IL-2 receptor.¹³ It is unclear whether the atypical rash noted in this case report may provide diagnostic clues about the presence of an occult malignancy. Regardless, in such cases, some suggest positron emission tomography and computed tomography (PET-CT) to evaluate for the presence of solid tumors.¹³

Kubra Bugdayli, MD, is a board-certified rheumatologist practicing at United Hospital Center, Bridgeport, W.Va. She completed her rheumatology fellowship at UT Southwestern Medical Center, Dallas.

Ahmed Eldaboush, MD, is a postdoctoral researcher at the University of Pennsylvania, Perelman School of Medicine, Philadelphia. He obtained his medical degree from Al-Azhar University, Cairo.

Sanjana Aggarwal, MBBS, is a medical graduate of Hamdard Institute of Medical Sciences and Research, Delhi, India. She is currently working in a secondary level government hospital in Delhi as a junior resident in the Department of Medicine.

Bonnie L. Bermas, MD, is the Dr. Morris Ziff Distinguished Professor in Rheumatology and clinical director of the Rheumatic Diseases Division at UT Southwestern Medical Center, Dallas.

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