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Aetiology is unknown but can be triggered by viral infections and other environmental factors in a susceptible genetic host. We present a case of AOSD triggered after exposure to a sap-like liquid while working in Africa. This inciting event occurred as part of a hostile act towards the patient and involved medicinal practices traditional to the area. Our case highlights the more chronic course of AOSD, which requires escalating biological treatment to avoid long-term corticosteroids, as well as the juncture between traditional and modern medical practices.<\/jats:p>","DOI":"10.1136\/bcr-2021-244156","type":"journal-article","created":{"date-parts":[[2021,10,28]],"date-time":"2021-10-28T12:31:28Z","timestamp":1635424288000},"page":"e244156","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Adult-onset Still\u2019s disease after environmental exposure while working in Africa"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2108-8315","authenticated-orcid":false,"given":"Emily L","family":"Gilbert","sequence":"first","affiliation":[{"name":"Rheumatology, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Wang","sequence":"additional","affiliation":[{"name":"Rheumatology, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,10,28]]},"reference":[{"key":"2025082701163104000_14.10.e244156.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2018.07.018"},{"key":"2025082701163104000_14.10.e244156.2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.3109\/07853890.2014.971052","article-title":"Adult-onset Still\u2019s disease\u2014pathogenesis, clinical manifestations, and new treatment options","volume":"2015","author":"Kadavath","year":"2015","journal-title":"Ann Med"},{"key":"2025082701163104000_14.10.e244156.3","doi-asserted-by":"publisher","DOI":"10.1136\/adc.16.87.156"},{"key":"2025082701163104000_14.10.e244156.4","doi-asserted-by":"publisher","DOI":"10.1136\/ard.30.2.121"},{"key":"2025082701163104000_14.10.e244156.5","first-page":"424","article-title":"Preliminary criteria for classification of adult still's disease","volume":"19","author":"Yamaguchi","year":"1992","journal-title":"J Rheumatol"},{"key":"2025082701163104000_14.10.e244156.6","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/S0140-6736(87)90204-2","article-title":"Increased serum ferritin levels in adult still's disease","volume":"1","author":"Ota","year":"1987","journal-title":"Lancet"},{"key":"2025082701163104000_14.10.e244156.7","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.berh.2016.08.003","article-title":"Adult-onset still's disease: advances in the treatment","volume":"30","author":"Casta\u00f1eda","year":"2016","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2025082701163104000_14.10.e244156.8","first-page":"17","article-title":"Adult-onset still's disease: current challenges and future prospects","volume":"8","author":"Siddiqui","year":"2016","journal-title":"Open Access Rheumatol"},{"key":"2025082701163104000_14.10.e244156.9","first-page":"33","article-title":"Treatment of adult-onset Still\u2019s disease: a Review","volume":"11","author":"Jamilloux","year":"2014","journal-title":"Therapeut Clin Risk Manag"},{"key":"2025082701163104000_14.10.e244156.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2014.08.032"},{"key":"2025082701163104000_14.10.e244156.11","doi-asserted-by":"crossref","first-page":"309","DOI":"10.3109\/03009742.2014.992949","article-title":"Efficacy and safety of biological agents in adult-onset still's disease","volume":"44","author":"Cavalli","year":"2015","journal-title":"Scand J Rheumatol"},{"key":"2025082701163104000_14.10.e244156.12","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-217155"},{"key":"2025082701163104000_14.10.e244156.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2017.06.006"},{"key":"2025082701163104000_14.10.e244156.14","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s12016-019-08747-8","article-title":"Autoinflammatory pathogenesis and targeted therapy for adult-onset still's disease","volume":"58","author":"Li","year":"2020","journal-title":"Clin Rev Allergy Immunol"},{"key":"2025082701163104000_14.10.e244156.15","article-title":"Real-Life Data on the Efficacy of Canakinumab in Patients with Adult-Onset Still\u2019s Disease","volume":"15","author":"Vitale","year":"2020","journal-title":"Mediators Inflamm"},{"key":"2025082701163104000_14.10.e244156.16","unstructured":"FDA . 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