Adult-onset Still's Disease With Pulmonary Involvement

Background Only a few earlier pathologic reports exist describing adult-onset Still's disease (AOSD) with pulmonary involvement. We report a case of AOSD with pulmonary involvement producing an organizing pneumonia pattern as seen on transbronchial lung biopsy (TBLB). Case A 67-year-old man was referred with fever, cough, and multiple joint pains. Chest x-ray revealed an infiltration in the right upper lung field, and chest high-resolution computed tomography showed a consolidation in the right upper lobe segment. The patient did not respond to multiple antibiotics, and remittent fever over 38°C persisted. The patient also developed a salmon-pink rash. AOSD was diagnosed according to specific diagnostic criteria. Organizing pneumonia was diagnosed by TBLB histology and radiologically, and the lesions were thought to be due to pulmonary involvement of AOSD. Treatment with prednisolone and a nonsteroidal anti-inflammatory drug immediately improved the parenchymal lesions. Conclusions AOSD can produce lung involvement. TBLB is useful in the diagnosis of pulmonary lesions.