{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:52:38Z","timestamp":1774936358247,"version":"3.50.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Fungal infections are uncommon but potentially life-threatening complications in adult-onset Still\u2019s disease (AOSD). The immunological features of AOSD patients with fungal infections remain poorly defined, and this study aimed to characterize immune activation profiles in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 277 patients diagnosed with AOSD, among whom 35 (12.6%) developed fungal infections. Clinical features and immunological parameters, including neutrophil CD64 (nCD64), myeloid-derived suppressor cells (MDSCs), activated T cells, and serum cytokine profiles, were compared between patients with and without fungal infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared to non-infected AOSD patients, those with fungal infections had a higher frequency of splenomegaly (60.0% vs. 33.5%, p = 0.0024), pulmonary infiltrates (57.1% vs. 20.2%, p &amp;lt; 0.001), and pericarditis (42.9% vs. 20.7%, p = 0.0038). Immunologically, the infection group showed significantly elevated levels of nCD64 (45.39 vs. 11.16, p &amp;lt; 0.05) and enhanced CD8\n                      <jats:sup>+<\/jats:sup>\n                      T cell activation, particularly CD8\n                      <jats:sup>+<\/jats:sup>\n                      CD38\n                      <jats:sup>+<\/jats:sup>\n                      T cells (81.54% vs. 66.89%, p &amp;lt; 0.05). Serum soluble IL-2R levels were also higher in infection patients (1884.18 vs. 1259.13 U\/mL, p &amp;lt; 0.05). Cytokines such as IL-8, and IL-10 were markedly elevated during infection episodes. Additionally, ferritin elevation remained independently associated with fungal infection after adjusting for disease activity, MAS, and glucocorticoid exposure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      AOSD patients with fungal infections exhibit distinct immune activation patterns involving neutrophils and CD8\n                      <jats:sup>+<\/jats:sup>\n                      T cells, reflecting dynamic immune changes during infection episodes. These immunological features may support integrated immune assessment and inform therapeutic considerations under immunosuppressive treatment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1798932","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T04:15:58Z","timestamp":1774930558000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Distinct immune activation patterns in adult-onset Still\u2019s disease with fungal infections"],"prefix":"10.3389","volume":"17","author":[{"given":"Tongxin","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ye","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuesong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]},{"name":"Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]},{"name":"Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University","place":["Shanghai, China"]},{"name":"Department of Allergy, Renji Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]},{"name":"Shanghai lmmune Therapy Institute","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liyang","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liangjing","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruru","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]},{"name":"Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen","place":["Erlangen, Germany"]},{"name":"Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum Erlangen","place":["Erlangen, Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2024-225853","article-title":"Systemic juvenile idiopathic arthritis and adult-onset Still's disease are the same disease: evidence from systematic reviews and meta-analyses informing the 2023 EULAR\/PReS recommendations for the diagnosis and management of Still's disease","volume":"83","author":"De Matteis","year":"2024","journal-title":"Ann Rheum Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.jaut.2018.07.018","article-title":"A comprehensive review on adult onset Still's 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