Fw: EDU: AOSD - Possible Triggering Agents

[Guest guest]

This is some information one of our esteemed members researched

for us, I kept it, and am sending it out for everyone's info. Thanks Caroline!

Smiles and regards

Cat

----- Forwarded Message -----

To: stillsdisease

Sent: Sunday, January 25, 2009 11:00:57 AM

Subject: EDU: AOSD - Possible Triggering Agents

Dear Ones All,

Below is a list articles researched on the Internet. They discuss Possible

Triggering Agents for Stills disease as related by Medical doctors, clinicians,

researchers. It seems from my research that the list is endless but here are

some of the top contenders.

 

Possible factors listed below include:

 

Rubella,

CMV (Cytomeglavirus) ,

Toxoplasma Gondii, 

Mumps,

EBV (Epstien-Barr Syndrome),

Parvovirus B19 infection,

HIV,

Yersinia Enterocolitica infection,,

Mycobacterium Marinum,

and many others.

 

The consensus is " Adult onset Still's disease may represent a reaction pattern

to certain infections. "    (quote take from http://ard.bmj. com/cgi/content/

abstract/ 47/9/764 )

 

In searching over a year for my own Stills Diagnosis, I was diagnosed and

treated for EBV, CMV and Cat Scratch Fever (depite not owning a cat nor being

around one for 20 years). NOTE: I had ALL of these at the same time plus a lot

of other diagnosis'.  (My doctor say I'm an Over Achiever! LOL)   My ANA has

been negative, positive and negative again.   My RH factor is always negative.  

My SED (ESR , sedimentation rate) has never been over 40.   My CRP is usually

elevated but not always over normal.   My most predominant factor for my lab

work is my CK or CPK depending on whose taking the blood for it. It's the same

test regardless.  Mine has been as high as 800's and currently is elevated above

normal in the 170's. (normal is not above 150) When we treated MY above

ailments, I still had symptoms and was diagnosed with Adult Onset Stills

Disease.

 

The specific cause for Stills is still out for debate but as you can see from

the information posted below, it DOES seem to be related to other triggering

agents for at least some of us. NOTE: Some of the information links below

require you to purchase the information. I was more interested in the findings

in the articles than the specific details of the articles but decided to post

the " for purchase " articles for the benefit of the doctors, medical teams and

researchers who visit our site.

 

Please remember that this information is solely for educational purposes and not

meant to replace your own medical teams expert advice and care.

 

Rubella infection in adult onset Still's disease

The aetiology of adult onset Still's disease remains unknown although some

authors have tried to relate it to a viral infection.1- 10 We describe here a

case of typical adult onset Still's disease with a seroconversion in the rubella

antibody titre to emphasise that it is probably more than a coincidental event.

A 26 year old woman was admitted because of fever with chills, a pruritic rash,

myalgia, sore throat and headache. At the time of physical examination the

temperature was 40°C and the pulse rate 104 beat/min. The rash consisted of

small pruritic macules over back, periorbicular, legs and arms. The pharynx was

erythematous. Some small cervical lymphadenopathies were detected. The leucocyte

count was 42.3 × 109 cells/l (93.2% neutrophils) and the haemoglobin

concentration was 79 g/l. Liver enzymes were slightly increased, aspartate

aminotransferase (AST) 0.80 µkat/l and alanine aminotransferase (ALT)

0.73 µkat/l, but increased to AST 11.77 µkat/l and ALT 7.68 µkat/l after

acetylsalicylic acid administration. Lactate dehydrogenase . . . [Full text of

this article] from http://ard.bmj. com/cgi/content/ extract/59/ 6/490c

 

Adult Still's disease associated with cytomegalovirus infection

Authors: Izumikawa, Kinichi1; Morinaga, Yoshitomo; Kondo, Akira; Hara,

Kohei; Izumikawa, Koichi; Miyazaki, Yoshitsugu; Kohno, Shigeru; Igari,

Narihiko; Akaboshi, Mana; Kawakami, Jun; Eguchi, Katsumi

Source: Journal of Infection and Chemotherapy, Volume 13, Number 2, April 2007 ,

pp. 114-117(4)

Publisher: Springer

Abstract:A 77-year-old woman was admitted to our hospital complaining of high

fever. The physical examination on admission indicated no abnormality. Although

several antibiotics were administered, the spiking high fever was not

alleviated. Two weeks after admission a macular rash appeared, and a high

concentration of serum ferritin was observed. At this point, Still's disease was

suspected, and the patient was referred to Nagasaki University Hospital. During

the prescribed course of prednisolone, hepatic enzymes gradually increased to

high titers accompanied by a positive test for cytomegalovirus (CMV) antigen.

The CMV antigen disappeared after ganciclovir administration, and the

concentration of serum ferritin decreased after steroid administration. In this

report, we attempt to portray the relation between the pathogenesis of

adult-onset Still's disease and the presence of CMV antigen.

http://www.ingentac onnect.com/ content/klu/ 10156/2007/ 00000013/ 00000002/

00000503

 

 

 

 

Adult-onset Still's disease associated to toxoplasma gondii infection

Journal

Clinical Rheumatology

Publisher

Springer London

ISSN

0770-3198 (Print) 1434-9949 (Online)

Issue

Volume 10, Number 3 / September, 1991

Category

Case Report

DOI

10.1007/BF02208701

Pages

326-327

Subject Collection

Medicine

SpringerLink Date

Monday, October 10, 2005

 

PDF (187.6 KB)Free Preview

Case Report

Adult-onset Still's disease associated to toxoplasma gondii infection

E. Balleari1   , M. Cutolo1 and S. Accardo1

(1) 

Department of Internal Medicine, University of Genova, Italy

(2) 

Istituto Scientifico di Medicina Interna, viale Benedetto XV, n. 6,

16132 Genova, Italy

Received: 19 November 1990   Revised: 28 February 1991   Accepted:

28 February 1991  

Summary  Adult- onset Still's disease is characterized by high spiking fever,

evanescent maculopapular rash and arthritis. Several recent reports have

associated its development with a variety of infectious agents. We describe the

case of a 25-year old woman presenting high fever, maculopapular rash and

seronegative polyarthritis associated with lymphoadenopathy, splenomegaly and

neutrophil leucocytosis together with acute acquired toxoplasmosis. Other causes

of systemic illness were excluded by appropriate laboratory, radiological and

histological investigations. Clinical, radiological and laboratory findings as

well as possible etiopathogenetic correlations among both pathological

conditions are discussed. Toxoplasma gondii should be considered as a further

possible triggering agent associated with the development of adult-onset Still's

disease.

http://www.springer link.com/ content/f0q50706 533514g4/

 

 

 

 

 

Link to several case studies with various links to Stills http://scholar.

google.com/ scholar?hl= en & lr= & q= related:_ gxLMoaauOwJ: scholar.google.

com/ & um=1 & ie=UTF-8 & sa=X & oi=science_ links & resnum= 7 & ct=sl-related

 

Still's disease and myocarditis associated with recent mumps infection.  

http://www.pubmedce ntral.nih. gov/articlerende r.fcgi?artid= 2428969

 

 

Abstract

We report the case of a 60-year-old woman who had recently been examined for

fever of unknown origin and who presented to our hospital with high fever and

myalgia, weakness, sore throat, and rash. The patient had a markedly elevated

serum ferritin concentration of 40,000 ng/mL and positive antinuclear antibodies

(ANA) with a titer of 1/200. Despite the presence of positive ANA, the patient

was diagnosed as having adult Still's disease (ASD). High-dose steroid therapy

resulted in a remarkable clinical improvement. Such a severe case of systemic

inflammatory response syndrome, masquerading as sepsis with a positive ANA test,

has not been reported previously, at least not in the last 15 years.

http://linkinghub. elsevier. com/retrieve/ pii/S09536205060 02822

 

 

(1998) Still's disease, severe thrombocytopenia, and acute hepatitis associated

with acute parvovirus B19 infection. http://www.nature. com/ncprheum/

journal/v3/ n6/full/ncprheum 0510.html

 

 

Adult onset Still's disease (AOSD) is a distinct clinical entity which affects

predominantly young adults aged 16-35 years. Onset in elderly individuals is

exceptional. Several reports have suggested a viral trigger in the pathogenesis

of this disease. We describe a 66-year-old woman who fulfilled the proposed

diagnostic criteria of AOSD and suffered concurrently from acute Epstein-Barr

virus (EBV) infection. http://cat.inist. fr/?aModele= afficheN & cpsidt=1605001

 

 

Still's disease associated with adenovirus infection and defect in adenovirus

directed natural killing.

A S Luder , V Naphtali , E Ben Porat , N Lahat

Department of Pediatrics, Carmel Hospital (Faculty of Medicine, Technion-Israel

Institute of Technology), Haifa.

Low natural killer (NK) activity towards adenovirus infected fibroblasts was

detected in the peripheral blood of a child with Still's disease and was not

normalised by the addition of interferon alfa or interleukin 2. NK cytotoxicity

directed at K 562 target cells or polio infected fibroblasts was normal. This

specific NK deficiency might have contributed to the development of the child's

Still's disease.

http://ard.bmj. com/cgi/content/ abstract/ 48/9/781

 

 

Grand Rounds in Rheumatology

Adult onset Still's disease and collapsing glomerulopathy: successful treatment

with intravenous immunoglobulins and mycophenolate mofetil   http://rheumatology

..oxfordjournals. org/cgi/content/ abstract/ 43/6/795

 

 

Still's disease associated with Yersinia enterocolitica infection.

Authors: Sijpkens Y.W.J.; Westendorp R.G.J.; Hazes J.M.W.; Tak P.P.

Source: The Netherlands Journal of Medicine, Volume 48, Number 5, May 1996 , pp.

53-54(2)

Publisher: Elsevier   http://www.ingentac onnect.com/ content/els/ 03002977/

1996/00000048/ 00000005/ art88537

 

 

http://cat.inist. fr/?aModele= afficheN & cpsidt=1449565

Titre du document / Document titleHepatitis A infection mimicking adult onset

Still's disease

Auteur(s) / Author(s)SRIDHARAN  S. ; MOSSAD S. ; HOFFMAN G. ;

Affiliation( s) du ou des auteurs / Author(s) Affiliation( s)Department of

Rheumatic and Immunological Diseases, and the Department of Infectious Diseases,

The Cleveland Clinic Foundation, Cleveland, Ohio, ETATS-UNIS

Résumé / AbstractFever, rash, and arthritis may be components of the prodrome of

viral hepatitis. In the absence of jaundice and abnormal liver function tests,

this form of polyarthritis is easily confused with primary autoimmune diseases.

Whereas the association of systemic illness with musculoskeletal symptoms and

numerous viral infections is well known, such an association with hepatitis A

has only been rarely reported. We describe a case of hepatitis A infection

mimicking adult onset Still's disease, and review the pathogenesis and

differential diagnosis of Still's disease and the extraarticular manifestations

of hepatitis.

 

 

Mycobacterium marinum tenosynovitis in a patient with Still's disease J.

Thariat, L. Leveque1, C. Tavernier and J. F. Maillefert

Department of Rheumatology,

1Department of Internal Medicine and Systemic Diseases, Dijon University

Hospital, Dijon, France

SIR, Still's disease is a systemic disease of unknown aetiology. The prolonged

corticosteroid therapy often required to induce remission, can predispose to

various infectious side-effects which are sometimes difficult to differentiate

from Still's disease manifestations. We describe the case of a young adult with

Still's disease and cutaneous and tenosynovial infection caused by Mycobacterium

marinum.

http://rheumatology .oxfordjournals. org/cgi/content/ full/40/12/ 1419

 

 

 

 

http://gateway. nlm.nih.gov/ MeetingAbstracts /ma?f=102217260. html

Still's disease with HIV infection: pathophysiological link or incidental

association?

Riche A, Rogez JP, Leport C, Bertin P, Gissot V, Vilde JL, Weinbreck P;

International Conference on AIDS. Int Conf AIDS. 1996 Jul 7-12; 11: 106

(abstract no. Mo.B.1297).

Service de Maladies Infectieuses, Limoges, France. Fax: 55-05-66-48.

Objective: We describe the first case of Adult onset Still's disease (AOSD)

revealing HIV infection. Material and Method: A 35-year-old white bisexual man

presented in July 1994 with three weeks of fever, sore throat, lymphadenopathy

and splenomegaly. He had leukocytosis with neutrophilia and anemia with high

level of ferritine and elevated erythocyte sedimentation rate. Serum rhumatoid

factor and antinuclear antibody were normal. The following weeks, he developed a

maculopapular rash on limbs which resolved after several days. HIV infection was

confirmed with CD4 cell count at 498/mm3. Multiple cultures and serological

tests were negative. There was no response to several trials of empiric

antibiotics. No typical or atypical infectious agent was isolated, and therefore

two months after onset he was treated with prednisone at 2 mg/kg pd for the

working diagnosis of AOSD. After one month of decreasing therapy, prednisone

resulted in resolution of symptoms

and normalization of his laboratory tests. However, under 1 mg/kg pd, he

developed several recurrences with arthritis involving wrists, knees and

shoulders. Other rheumatologic manifestations were eleminated by further

explorations. Follow-up has now lasted 18 months, isotopic synoviorthesis of

large joints led to a decrease to 0.5 mg/kg pd of prednisone associated with

nonsteroidal antiinflammatory drugs. HIV infection had progressed (CD4: 40/mm3)

in spite of antiretroviral therapy (zidovudine and didanosine), without

opportunistic infections. In 1996, he developed a Kaposi's sarcoma. Conclusion:

According to ARA, our patient's disease fulfilled the criteria for AOSD. Various

rheumatologic manifestations of HIV infection have been described. Furthermore,

to our knowledge, HIV infection has never been associated with AOSD. Whether HIV

infection played a role in our patient or was a coincidence remains unknown.

This case report underlines the

difficulties in using immunosuppressive drugs for rheumatologic disorders in

HIV-infected patients.Publicatio n Types:

Meeting AbstractsKeywords:

Acquired Immunodeficiency Syndrome

Adult

Animals

Arthritis, Juvenile Rheumatoid

HIV

HIV Seropositivity

HIV-1

Humans

Male

Recurrence

Still's Disease, Adult-Onset Other ID:

96921361UI: 102217260

(Beautiful Southern Oregon, USA)

We may not be able to change the direction of the wind, but we can adjust our

sails.

May you have enough happiness to make you kind, enough trials to make you

strong, enough sorrow to keep you human, enough hope to make you happy.

 

 

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