• Yuya Fujita, Shuzo Sato, Haruki Matsumoto, Jumpei Temmoku, Makiko Yashiro-Furuya, Naoki Matsuoka, Tomoyuki Asano, Kohei Yokose, Shuhei Yoshida, Mikio Ohtsuka, Hiroshi Watanabe, and Kiyoshi Migita.
• Department of Rheumatology, Fukushima Medical University School of Medicine.
• Tohoku J. Exp. Med. 2021 Dec 1; 255 (4): 297-301.

AbstractA 38-year-old male was admitted to our hospital for arthralgia, fever, skin rash, and purpura. He was diagnosed as having adult-onset Still's disease (AOSD) based on Yamaguchi's criteria. Skin biopsy revealed immunoglobulin A (IgA) vasculitis. He was also found to have anti-cyclic citrullinated peptide (CCP) antibody-positive inflammatory arthritis on a shoulder joint, however he did not fulfill classification criteria for rheumatoid arthritis. Elevated serum cytokine such as serum IL-18 supported the diagnosis of AOSD. His symptoms improved with 40 mg of prednisolone plus cyclosporin A (200 mg/day). Two years after hospitalization, AOSD was relapsed with pleurisy and hyperferritinemia. Finally, he was diagnosed with multicyclic systemic type of AOSD complicated by IgA vasculitis and seropositivity of anti-CCP antibody. Clinicians need to consider the complication of multiple rheumatic diseases, even if the disease-specific autoantibody is positive.

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