AN UNUSUAL CAUSE OF PERICARDIAL AND PLEURAL EFFUSIONS

SESSION TITLE: Pulmonary Manifestations of Systemic Diesase SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Adult-Onset Still’s Disease (AOSD) is an uncommon inflammatory disorder, characterized by daily fever, arthritis and rash, thought to affect 0.16 per 100000 persons. Etiology remains unknown: however, many theories propose viral and bacterial infections as triggers of the disease. CASE PRESENTATION: A 76-yr-old female, current smoker with a PMH of COPD, presents with fever, productive cough, dyspnea and arthralgia for six days and bloodwork significant for leukocytosis and positive Coxsackie B2 titers. Imaging showed a pericardial effusion as well as bilateral pleural effusions. She then underwent a thoracentesis with drainage of a transudative fluid. She was started on steroids for 5 days with improvement in her symptoms and discharged home with a presumed diagnosis of a viral pleuropericarditis. After an initial improvement, she noted to be increasingly short breath despite an outpatient course of antibiotics and returned to the hospital 2 weeks later with hypoxemic and hypercapnic respiratory failure. She is found to have recurrent bilateral pleural effusions, one of which again drained and was found to be transudative. Further infectious workup was negative, however labs were notable for a very elevated ferritin. She was assumed to have AOSD, having met 4/5 of the Yamaguchi criteria (fever, arthralgia, leukocytosis, negative ANA) and 5 of Fautrels Criteria (major: fevers, arthralgia, PMNs>80%, high ferritin, minor: leukocytosis). She was started again on steroids and her fever as well as leukocytosis resolved with great clinical improvement. She was discharged on colchicine and steroids with further resolution of her symptoms as well as her pleural and pericardial effusions. DISCUSSION: AOSD has rarely been described above the age of 70, with a usual bimodal distribution at 15-25 and 36-45 years of age. This case exhibits a rare presentation of a rare disease, and highlights the breadth in differential diagnoses required when considering pleuropericarditis in the geriatric population. CONCLUSIONS: Although unusual, AOSD can occur in the elderly and present with pleural and pericardial effusions. Reference #1: Magadur-Joly G, Billaud E, Barrier JH, Pennec YL, Masson C, Renou P, et al. Epidemiology of adult Still’s disease:estimate of the incidence by a retrospective study in west France. Ann Rheum Dis 1995;54:587e90 Reference #2: Wouters JM, van der Veen J, van de Putte LB, de Rooij DJ. Adult onset Still’s disease and viral infections. Ann Rheum Dis 1988;47:764e7 DISCLOSURES: No relevant relationships by Bushra Mina, source=Web Response No relevant relationships by Maly Oron, source=Web Response No relevant relationships by Elizabeth Sharp, source=Web Response