Enfermedad de Still del adulto asociada a endocarditis marántica: reporte clínico y revisión de literatura

Varon de 52 anos, 9 meses de enfermedad, caracterizado por artralgias, fiebre alta, exantema evanescente, diaforesis, faringitis, astenia y baja de peso. Al examen: linfadenomegalia, taquicardia, soplo sistolico III/VI mitral y aortico, Catalogado como fiebre de origen desconocido, Ecografia abdominal: hepato-esplenomegalia leve; ecocardiografia transesofagica: masa calcificada de 4,5 x 8 mm en valvula aortica y leve efusion pericardica; tomografia abdominal: hepatoesplenomegalia leve, ganglios paraaorticos abdominales y una imagen captadora de contraste en hilio renal derecho de 15 x 25 mm, de bordes definidos. Leucocitosis neutrofilica, anemia moderada, ferritina > 2 000 ng/ ml., FR, ANA Y ANCA negativos. Ganglio cervical: reaccion inflamatoria inespecifica; histopatologia del tumor renal: carcinoma renal de celulas claras. A pesar de exeresis del tumor renal, la fiebre persistia; por exclusion, se diagnostico enfermedad de Still del adulto (ESA) asociado a endocarditis trombotica no bacteriana (ETNB); recibio prednisona 1 mg/kg, con respuesta favorable. CONCLUSION. La ESA es un trastorno inflamatorio inmune caracterizado por la triada de fiebre, exantema evanescente y artralgias, asociado a otros signos y sintomas y pruebas de laboratorio inespecificas, pero muy sugestivas. El diagnostico es por exclusion. El tumor renal sed a la causa de ETNB y desencadenante de la ESA. This is a 52-year-old male, with a 9-month of illness, characterized by arthralgias, high fever, evanescent rash, pharyngitis, weight loss. Examination, lymphadenopathy; tachycardia, III/VI systolic murmur in mitral and aortic areas. It was considered as fever of unknown origin. Abdominal ultrasound: mild hepato-splenomegaly; transesophageal echocardiography: calcified mass of 4,5 x 8 mm in the aortic valve and mild pericardial effusion; abdominal tomography: mild hepato-splenomegaly, abdominal para-aortic lymph nodes and an image with contrast uptake at the level of the right renal hilum of 15 x 25 mm, with defined borders. Moderate leukocytosis with neutrophilia, moderate anemia, ferritin > 2000 ng/mL, negative for RF, ANA and ANCA. Cervical lymph node: unspecific inflammatory reaction; histopathology from the renal tumor: clear-cell renal carcinoma. Despite removal of the renal tumor, the fever persisted; by exclusion, was diagnosed as adult Still's disease (ASD) associated with non-bacterial thrombotic endocarditis (NBTE); treatment was initiated with prednisone at 1 mg/kg, obtaining positive result. Conclusion. Adult Still's disease (ASD) is an immune disorder characterized by the trio fever, evanescent rash and arthralgia or arthritis, accompanied others signs and symptom and laboratory essay. The diagnosis is made by exclusion. The renal tumor would have been the cause of the NBTE and unchain of the ASD.