{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:03:16Z","timestamp":1789966996176,"version":"4.0.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"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. Med."],"abstract":"<jats:p>Adult-onset Still's disease (AOSD) is a rare autoinflammatory disease, the clinical manifestations of which often overlap with other diseases such as lymphoma. This overlap makes differential diagnosis difficult, especially in patients with generalized lymphadenopathy, splenomegaly, and systemic metabolic hyperactivity. In this article, we discuss a 53-year-old East Asian (Chinese) female patient who had a fever, transient rash, generalized lymphadenopathy, and splenomegaly. An 18F-FDG PET\/CT scan showed diffuse hypermetabolism in multiple lymph nodes, her spleen, and her bone marrow, and her serum ferritin level was elevated at 15,485\u2005ng\/mL, leading to strong suspicion of lymphoma. However, an excisional biopsy of the right inguinal lymph nodes with pathological, immunohistochemical, and T-cell receptor gene rearrangement analyses showed no evidence of clonality or lymphoma. Given the typical clinical presentation and laboratory findings, the patient was diagnosed with AOSD according to the Yamaguchi classification criteria. Glucocorticoid therapy rapidly normalized the patient's temperature, the rash disappeared, her lymph nodes decreased in size, and her ferritin and inflammation levels significantly decreased, suggesting a good therapeutic response. This case illustrates the value of lymph node biopsy in AOSD with \u201clymphoma-like\u201d imaging features. Moreover, ferritin is a critical biomarker and is crucial for early identification of such difficult cases.<\/jats:p>","DOI":"10.3389\/fmed.2026.1886283","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T04:28:15Z","timestamp":1789964895000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Breaking the diagnostic dilemma of \u201clymphoma-like\u201d presentation: a case of adult-onset Still's disease characterized by generalized lymphadenopathy and extremely elevated ferritin"],"prefix":"10.3389","volume":"13","author":[{"given":"Yanhui","family":"Duan","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Shenzhen University General Hospital, Shenzhen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Shenzhen University General Hospital, Shenzhen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Shenzhen University General Hospital, Shenzhen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Shenzhen University General Hospital, Shenzhen University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1007\/s11739-024-03766-6","article-title":"Anakinra in the management of adult-onset Still's disease: a single-center 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