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Case Reports in Medicine
Volume 2012 (2012), Article ID 349521, 3 pages
http://dx.doi.org/10.1155/2012/349521
Case Report

Adult-Onset Still’s Disease Masquerading as Sepsis in an Asplenic Active Duty Soldier

1Department of Internal Medicine, Tripler Army Medical Center, 1 Jarrett White Road Honolulu, HI 96859, USA
2Department of Rheumatology, Tripler Army Medical Center, Honolulu, HI 96859, USA
3Department of Infectious Disease, Tripler Army Medical Center, Honolulu, HI 96859, USA

Received 10 September 2012; Revised 22 October 2012; Accepted 29 October 2012

Academic Editor: Jagdish Butany

Copyright © 2012 Nathan T. Jaqua et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This is a case of a 26-year-old active duty male with a history of idiopathic thrombocytopenic purpura (ITP) and surgical asplenia who presented with a one-week history of fevers, myalgias, arthralgias, and rigors. His evaluation upon presentation was significant for a temperature of 103 degrees F, white blood cell count of 36 K with a granulocytic predominance, and elevated transaminases. He was treated empirically with broad-spectrum antibiotics with concern for a systemic infection with an encapsulated organism. During his stay, he developed four SIRS criteria and was transferred to the progressive care unit for suspected sepsis. He continued to have twice-daily fevers and a faint, salmon-colored centripetal rash was eventually observed during his febrile episodes. After a nondiagnostic microbiologic and serologic workup, he was diagnosed with adult-onset Still’s Disease and started on intravenous methylprednisolone with brisk response. He was discharged on oral prednisone and was started on anakinra. Adult-onset Still’s disease is a rare condition that presents with varying severity, and this is the first reported case, to our knowledge, of its diagnosis in an asplenic patient. Its management in the setting of asplenia is complicated by the need for antibiotic therapy with each episode of fever.