Abstract
Adult-onset Still's disease (AOSD) is a systemic inflammatory disease characterized by a high spiking fever with an evanescent rash, arthritis, and multiple organ involvement. Cardiopulmonary manifestations of AOSD include pericarditis and pleuritis, but myocarditis is rare. We report a 39-year-old man with AOSD who was diagnosed while hospitalized for myocarditis. The patient presented with diarrhea and vomiting and was admitted to a neighborhood hospital. On the following day, an electrocardiogram showed a diffuse ST elevation, and an elevated troponin T level was observed. Because coronary angiography did not reveal any abnormalities, myocarditis was suspected. The patient developed hypoxia and pulmonary effusion, so mechanical ventilation (MV) and intra-aortic balloon pumping (IABP) were initiated. The patient was transferred to our hospital and admitted to the ICU with IABP and MV. Shortly thereafter, percutaneous cardiopulmonary support (PCPS) was initiated. A myocardial biopsy led to a diagnosis of myocarditis. The patient's cardiac function improved thereafter. The patient was weaned from PCPS and IABP on the 3rd and 4th ICU days, respectively, however, MV was continued because of tachypnea caused by a high fever. On the 5th ICU day, a rash appeared and spread to the proximal limbs and trunk. After ruling out infections and malignancies, the patient was diagnosed as having AOSD, and treatment with corticosteroids was initiated on the 14th ICU day. The patient's fever improved, and his respiratory rate decreased. The patient was weaned from MV on the 20th ICU day, and discharged to the general ward on the 23rd ICU day.
