Case report
Extreme Hyperferritinaemia in Adult-onset Still’s Disease Mimicking Infection and Malignancy: A Case Report
OD07-OD09
Correspondence
Ankit Notwani,
S/12, E-block Gents Hostel, Sree Balaji Medical College and Hospital,
Chromepet-600044, Chennai, Tamil Nadu, India.
E-mail: ankit.notwani2@gmail.com
Adult-Onset Still’s Disease (AOSD) is a rare systemic inflammatory disorder characterised by quotidian fever, evanescent rash, and inflammatory arthralgia. It often presents as a diagnosis of exclusion due to its clinical heterogeneity and lack of specific diagnostic markers, particularly in patients presenting with Fever of Unknown Origin (FUO). Hyperferritinaemia is a well-recognised laboratory feature, with markedly elevated levels reflecting severe systemic inflammation. However, extreme hyperferritinaemia is not specific to AOSD and may also be observed in infections, malignancies, and hyperinflammatory conditions such as Macrophage Activation Syndrome (MAS), making diagnosis challenging. Hereby, the authors present a case of a 35-year-old male presenting with high-grade fever, migratory polyarthralgia, transient erythematous rash, generalised lymphadenopathy, and significant weight loss, accompanied by markedly elevated serum ferritin levels. Extensive evaluation excluded infectious, malignant, and autoimmune causes. Imaging studies demonstrated reactive lymphadenopathy, splenomegaly, and bone marrow activation, supporting a systemic inflammatory process. The patient showed rapid clinical improvement following corticosteroid therapy. This case is notable for extreme hyperferritinaemia with multisystem involvement in the absence of MAS, along with a presentation mimicking infection and malignancy. It underscores the importance of considering AOSD in patients with FUO and markedly elevated ferritin levels to facilitate timely diagnosis and management.