Abstract
Background
Adult-onset Still’s disease (AOSD) is a rare inflammatory disease of unknown etiology that can present for the first time during pregnancy. Pure red cell aplasia (PRCA) is another rare condition that seldom is in association with AOSD. Herein, we have reported a newly diagnosed case with AOSD and PRCA in a previously healthy pregnant woman.
Case description
A 25-year-old primigravida lady presented with fever, malaise, and arthralgia at 26 weeks of gestation. She had an extensive evaluation that led to the diagnosis of AOSD. Preliminary blood tests displayed a severe anemia with hemoglobin 5.1 g/dL, leukocytosis (total white blood cells count of 26,000 μL−1), normal mean corpuscular volume, normal mean corpuscular hemoglobin, normal platelet count, and a low reticulocyte count (0.2 %). The condition was diagnosed as AOSD associated with PRCA. She was treated with prednisolone and had immediate and dramatic improvement.
Conclusion
AOSD and PRCA in pregnancy are rare conditions. The recognition of these clinical syndromes may lead to earlier diagnosis and thus prevent the expensive investigations. Both conditions have a dramatic improvement upon using corticosteroids therapy.
Abbreviations
- AOSD:
-
Adult-onset Still’s disease
- CRP:
-
C-Reactive protein
- ESR:
-
Erythrocyte sedimentation rate
- MCH:
-
Mean corpuscular hemoglobin
- MCV:
-
Mean corpuscular volume
- PRCA:
-
Pure red cell aplasia
- RBC:
-
Red blood cell
- WBC:
-
White blood cell
References
Lee LA, Werth VP (2012) The skin and rheumatic disease. In: Firestein GS, Budd RC, Gabriel SE et al (eds) Kelley’s textbook of rheumatology, chap 43, 9th edn. Saunders Elsevier, Philadelphia
Owlia MB, Mehrpoor G (2009) Adult-onset Still’s disease: a review. Indian J Med Sci 63(5):207–221
Magadur-Joly G, Billaud E, Barrier JH, Pennec YL, Masson C, Renou P, Prost A (1995) Epidemiology of adult Still’s disease: estimate of the incidence by a retrospective study in West France. Ann Rheum Dis 54(7):587–590
Cush JJ, Medsger TA Jr, Christy WC, Herbert DC, Cooperstein LA (1987) Adult-onset Still’s disease: clinical course and outcome. Arthritis Rheum 30(2):186–194
van de Putte LB, Wouters JM (1991) Adult-onset Still’s disease. Baillieres Clin Rheumatol 5(2):263–275
Ohta A, Yamaguchi M, Kaneoka H, Nagayoshi T, Hiida M (1987) Adult Still’s disease: review of 228 cases from the literature. J Rheumatol 14(6):1139–1146
Still GF (1897) On a form of chronic joint disease in children. Med Chir Trans 80:47–60.9
Still GF (1941) On a form of chronic joint disease in children. Arch Dis Child 16(87):156–165
Bywaters EG (1971) Still’s disease in the adult. Ann Rheum Dis 30(2):121–133
Stein GH, Cantor B, Panush RS (1980) Adult Still’s disease associated with pregnancy. Arthritis Rheum 23(20):248–250
Saha M, Ray S, Kundu S, Chakrabarti P (2013) Pure red cell aplasia following autoimmune hemolytic anemia: an enigma. J Postgrad Med 59(1):51–53
Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H, Kashiwazaki S et al (1992) Preliminary criteria for classification of adult Still’s disease. J Rheumatol 19(3):424–430
Mehrpoor G, Owlia MB, Soleimani H, Ayatollahi J (2008) Adult-onset Still’s disease: a report of 28 cases and review of the literature. Mod Rheumatol 18(5):480–485
Sampalis JS, Medsger TA, Fries JF, Yeadon C, Sene’cal JL, Myhal D, Harth M et al (1996) Risk factors for adults Still’s disease. J Rheumatol 23(12):2049–2054
Pan VL, Haruyama AZ, Guberman C, Kitridou RC, Wing DA (2003) Newly diagnosed adult-onset Still disease in pregnancy. Obstet Gynecol 101(5 Pt 2):1112–1116
Cush JJ (2000) Adult-onset Still’s disease. Bull Rheum Dis 49(6):1–4
Fautrel B, Zing E, Golmard JL, Le Moel G, Bissery A, Rioux C, Rozenberg S et al (2002) Proposal for a new set of classification criteria for adult-onset still disease. Medicine (Baltimore) 81(3):194–200
Masson C, Le Loet X, Liote F, Dubost JJ, Boissier MC, Perroux-Goumy L et al (1996) Comparative study of 6 types of criteria in adult Still’s disease. J Rheumatol 23(3):495–497
Nguyen KH, Weisman MH (1997) Severe sore throat as a presenting symptom of adult-onset Still’s disease: a case series and review of the literature. J Rheumatol 24(3):592–597
Cagatay Y, Gul A, Cagatay A, Kamali S, Karadeniz A, Inanc M, Ocal L, Aral O, Konice M (2009) Adult-onset Still’s disease. Int J Clin Pract 63(7):1050–1055
Robillard N, Nguyen PV, Wistaff R, Laskine MN (2013) Pure red cell aplasia with adult onset Still’s disease. Case Rep Med 2013:308342
Comondore V, Patterson AC, Zypchen L, Dalal B (2008) Pure red cell aplasia in a patient with adult-onset Still’s disease. Am J Hematol 83(8):687–688
Janssen HL, van Laar JM, van Hoek B, den Ottolander GJ, van Krieken JH, Breedveld FC (1999) Severe hepatitis and pure red cell aplasia in adult Still’s disease: good response to immunosuppressive therapy. Dig Dis Sci 44(8):1639–1642
Chung JW, Suh YJ, Song HJ, Choi JH, Park HS, Cho SR, Suh CH (2004) Pure red cell aplasia and adult-onset Still’s disease. Clin Rheumatol 23(4):368–370
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Moussa, M., Hassan, M.F. Newly diagnosed adult-onset Still’s disease with pure red cell aplasia in pregnancy. Arch Gynecol Obstet 290, 195–198 (2014). https://doi.org/10.1007/s00404-014-3184-x
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DOI: https://doi.org/10.1007/s00404-014-3184-x