Doença de still no adulto e suas particularidades: um relato de caso

• Autor(a) principal: Carvalho, Maria Marina da Nóbrega
• Data de Publicação: 2021
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório do Centro Universitário Braz Cubas
• Texto Completo: https://repositorio.cruzeirodosul.edu.br/handle/123456789/2874
• topic: Doença de still no adulto; Idosa; Doença inflamatória sistêmica; CNPQ::CIENCIAS DA SAUDE::MEDICINA

Introduction: Still-onset adult disease is a rare systemic inflammatory disease with wide involvement. Its etiology is unknown. It starts in early adulthood in typical cases, and can rarely affect ages over 70 years. The absence of specific diagnostic tests, the vast clinical picture and age are factors that influence the difficulty of diagnosis. Thus, it is possible to see that the rarity of such cases and their clinical and epidemiological particularities can delay the proper management of such patients. Objectives: the objective of this work is to describe a clinical case of adult Still's disease with an unusual presentation focusing on the description of its particularities. Methodology: The research was carried out using data from the care provided at Clínica Med Prime, in João Pessoa - PB, with data collection during the months of September, October and November, with the approval of the Research Ethics Committee. Data analysis was performed based on the described report, correlating its clinical, laboratory and image exam aspects. Case Report: Female, 82 years old, arrives at the outpatient clinic, revealing eight years of evolution of intermittent febrile conditions, with spots spread throughout the body, arthralgia, pharyngitis and alterations in laboratory and imaging exams. His laboratory tests showed anisocytosis, microcytosis, leukocytosis, ferritin and elevated CRP, negative ANA, normal complement, hypergammaglobulinemia. She was diagnosed in 2012 with Still's disease. She has evolved with several hospitalizations. It had peaks about ten times a month. Cardiac and pulmonary complications were diagnosed. She had two episodes of DVT. She started treatment with Hydroxychloroquine 400 mg and Prednisone 20 mg, which significantly reduced events. She continued with episodes of fever with each attempt to wean off prednisone. Discussion: The patient started the condition at the age of 74, an unusual age group of the disease. Corroborative picture with Yamaguchi criteria: fever higher than 39ºC, arthralgia, rash on extremities during febrile crises, leukocytosis, RF negativity and antinuclear antibodies. Differential diagnoses were studied to be discarded. Fautrel's criteria are also positive. There was an intermittent pattern, with remission between episodes, bringing systemic characteristics and complications, and eight years of evolution. Chronic disease anemia is present. Still is also associated with thrombotic events, as was the case with DVT. Few data suggest the benefit of Hydroxychloroquine, however there was good control of the disease with it. Conclusion: The present study presented a case of Adult Still's Disease with several peculiarities, affecting an elderly patient with a diverse, persistent clinic, presenting complications, with an unfavorable prognosis.