Clinical rheumatology, 1989, 8, N ~ 3 339-344 Case Report Adult onset Still's disease N. ARBER, A. WEINBERGER, R. FADILA, Y. SIDI, J. PINKHAS Department of Internal Medicine "D", Beilinson Medical Center, Petah Tikva, Israel. SUMMARY Three patients with adult onset of Still's disease are presented. Common early findings were': septic fever, polyarthralgia, leukocytosis, neutrophilia and elevated sedi- mentation rate. All of them had abnormal liver function tests which returned to normal val- ues following corticosteroid therapy. It is proposed that hepatic abnormalities in adult onset of Still's disease reflect the basic disease process. Key words: Adult Onset Still's Disease, Liver Function Tests. INTRODUCTION In 1897, G.F. Still described 22 children suffering from chronic polyarthritis (1). The term adult onset Still's disease was first used by Bywaters in 1971 (2) and since that time the disease has become increasingly recog- nized (2,3,4) as an inflammatory process that presents with high spiking fever, evanescent maculopapular rash, arthralgia (or arthritis), myalgia, lymphadenopathy, sore throat, leu- kocytosis with neutrophilia, elevated sedi- mentation rate and anaemia without any characteristic serologic abnormalities or aeti- ologic agents (4,5). Early diagnosis can be difficult because clinical manifestations and pathological find- ings are all nonspecific (5). There are several published reports of Still's disease with he- patic dysfunction (6). It is proposed that he- patic abnormalities in Still's disease frequent- ly reflect the underlying disease (7). Received 1 July 1988, Revision-accepted 24 January 1989 Correspondence to : Dr. N. ARBER, Department of Internal Medicine "D", BeilinsonMedi- cal Center, 49 100 Petah Tikva, Israel. We report three cases of adult onset Still's disease, with evidence of some abnormality of liver function tests. These biochemical ab- normalities vanished following corticosteroid treatment. PATIENTS AND METHODS Case 1 A 30-year-old Ashkenazi Jew was admitted for evaluation of a long-standing intermittent fever and arthritis. At the age of 13 he was treated with corticosteroids for polyarthritis. In 1975, he was hospitalized again due to fever and polyarthritis of three months dura- tion. The possibility of dermatomyositis was raised and he was again treated with cortico- steroids. He was free of symptoms for almost 3 years. In 1978, there was another flare-up (Table I, Table II), which included fever, poly- arthritis, lymphadenopathy, hepatosplenom- egaly and pleural effusion. On admission his body temperature was 40.0~ pulse 96, and blood pressure 140/90mmHg. Arthritis in both knees as well as in the metacarpopha- langeal and interphalangeal joints was found.