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Endocarditis in Adult-onset Still Disease: A Case Report and Literature Review

To the Editor: 

Adult-onset Still disease (AOSD) is one of the most common autoinflammatory conditions responsible for fevers of unknown origin. AOSD is characterized by prolonged spiking fever, arthritis, evanescent rash, leukocytosis, and multiorgan involvement. Endocarditis, especially the right-sided type, is extremely rare in AOSD. Here we report a case of noninfective endocarditis in the tricuspid valve caused by AOSD.

An 18-year-old man who had a high fever and evanescent rashes in the chest for 3 weeks was admitted to our hospital. His fever was typically > 39°C and was accompanied by intermittent sore throat, polyarthralgia, and abdominal pain. There were 1 or 2 spiking fevers in a day (in the afternoon or evening), which showed good response only to dexamethasone. He had no history of other diseases and had not stayed in any epidemic areas. He stated that he did not have any drug addiction or allergies.

In physical examinations, he had tenderness in his shoulder and knee joints, no enlargement of lymph nodes, and had abdominal rigidity. Vital signs revealed fever and … 

Address correspondence to Dr. X. Zhang, Department of Rheumatology, Sir Run Run Shaw Hospital, Zhejiang University, No. 3 East QingChun Road, Hangzhou, China. E-mail: 3408234{at}zju.edu.cn.