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Case Reports in Rheumatology
Volume 2013 (2013), Article ID 767684, 3 pages
http://dx.doi.org/10.1155/2013/767684
Case Report

Still's Disease in a Pediatric Patient after Liver Transplantation

1Unit of Internal Medicine, Fundación Valle del Lili, CES University, Cali, Colombia
2Clinical Investigative Unit, Fundación Valle del Lili, Cali, Colombia
3Unit of Rheumatology, Fundación Valle del Lili, ICESI University, Cra 98 No. 18-49, Cali, Colombia

Received 8 September 2013; Accepted 3 October 2013

Academic Editors: U. Gresser, M. A. Hunt, and S. Koarada

Copyright © 2013 Juan-Carlos Meza 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

Still's disease (SD) is a multisystemic inflammatory disease characterized by persistent arthritis and in many cases with fever of unknown origin. Diagnosis of SD is challenging because of nonspecific characteristics and especially in the case of a patient with solid organ transplantation and immunosuppressive therapy where multiple causes of fever are possible. There is no diagnostic test for SD, even though some useful diagnostic criteria or laboratory findings, such as serum ferritin levels, have been proposed, and useful imaging studies for the diagnosis or followup of SD have not been developed. We report the case of a 9-year-old child who presented with high grade fever associated with joint pain after a history of liver transplantation and immunosuppressive therapy. Laboratory tests showed increased acute phase reactants, elevated ferritin, and leukocytosis. An 18 F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) was performed identifying abnormal hypermetabolic areas localized in spleen, transplanted liver, and bone marrow secondary to inflammatory process. All infectious, autoimmune, and malignant causes were ruled out. A diagnosis of SD was performed and a steroid-based regimen was initiated with adequate response and no evidence of recurrence. To our knowledge this is the first case of SD following a solid organ transplant.