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During admission she developed deranged liver functions with right upper quadrant tenderness, pleural and pericardial effusions. This was followed by multiple joint aches, mouth ulcers and a rash on her chest. Finally, after several days and clinical dilemma, she was diagnosed with adult-onset Still\u2019s disease by the rheumatologist and was started on prednisolone, to which she showed marked improvement, and was later maintained on methotrexate and hydrotherapy. She was in remission during her follow-up in the rheumatology clinic.<\/jats:p>","DOI":"10.1136\/bcr-2018-228210","type":"journal-article","created":{"date-parts":[[2019,4,26]],"date-time":"2019-04-26T06:19:13Z","timestamp":1556259553000},"page":"e228210","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Complex presentation of adult-onset Still\u2019s disease"],"prefix":"10.1136","volume":"12","author":[{"given":"Muhammad","family":"Zafran","sequence":"first","affiliation":[{"name":"Respiratory, Great Western Hospitals NHS Foundation Trust, Swindon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2644-3478","authenticated-orcid":false,"given":"Nancy","family":"Wassef","sequence":"additional","affiliation":[{"name":"Cardiology, Plymouth Hospitals NHS Trust, Plymouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,4,25]]},"reference":[{"key":"2025082701113143000_12.4.e228210.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2014.01.058"},{"key":"2025082701113143000_12.4.e228210.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-010-1529-8"},{"key":"2025082701113143000_12.4.e228210.3","article-title":"Adult Onset Still\u2019s Disease: A Review on Diagnostic Workup and Treatment Options","volume":"2016","author":"Gopalarathinam","year":"2016","journal-title":"Case Rep Rheumatol"},{"key":"2025082701113143000_12.4.e228210.4","doi-asserted-by":"publisher","DOI":"10.3109\/07853890.2014.971052"},{"key":"2025082701113143000_12.4.e228210.5","doi-asserted-by":"publisher","DOI":"10.1038\/ncprheum0510"},{"key":"2025082701113143000_12.4.e228210.6","first-page":"424","article-title":"Preliminary criteria for classification of adult Still\u2019s disease","volume":"19","author":"Yamaguchi","year":"1992","journal-title":"J Rheumatol"},{"key":"2025082701113143000_12.4.e228210.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h3692"},{"key":"2025082701113143000_12.4.e228210.8","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-200205000-00003"},{"key":"2025082701113143000_12.4.e228210.9","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000001554","article-title":"Efficacy of Anakinra in Refractory Adult-Onset Still\u2019s Disease: Multicenter Study of 41 Patients and Literature Review","volume":"94","author":"Ortiz-Sanju\u00e1n","year":"2015","journal-title":"Medicine"},{"key":"2025082701113143000_12.4.e228210.10","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1002\/art.38398","article-title":"Efficacy of tocilizumab in conventional treatment-refractory adult-onset Still\u2019s disease: multicenter retrospective open-label study of thirty-four patients","volume":"66","author":"Ortiz-Sanju\u00e1n","year":"2014","journal-title":"Arthritis Rheumatol"},{"key":"2025082701113143000_12.4.e228210.11","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1080\/1744666X.2018.1536548","article-title":"Anakinra for the treatment of adult-onset Still\u2019s disease","volume":"14","author":"Casta\u00f1eda","year":"2018","journal-title":"Expert Rev Clin Immunol"},{"key":"2025082701113143000_12.4.e228210.12","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.berh.2016.08.003","article-title":"Adult-onset Still\u2019s disease: Advances in the treatment","volume":"30","author":"Casta\u00f1eda","year":"2016","journal-title":"Best Pract Res Clin Rheumatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-228210","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:11:40Z","timestamp":1756282300000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-228210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":12,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4,25]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1136\/bcr-2018-228210"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-228210","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}