Abstract

A 29-year-old African woman with active adult-onset Still’s disease (AOSD) that developed at the end of 2018 presented to our hospital in September 2019 with pleuritic right-sided pain and respiratory insufficiency of almost a month’s duration, which had failed to respond to high-dose corticosteroid and antibiotic treatment. A thoracic CT revealed right pleural effusion, multiple consolidations and pulmonary collapse. Besides pulmonary symptoms, the patient had arthralgia, fever, a salmon-coloured rash, leucocytosis and rising inflammatory markers. After an AOSD flare diagnosis was established, intravenous methylprednisolone and painkillers were administered. Due to the severity of the pleural effusion and the lack of response to previous treatments, subcutaneous anakinra was started. Two days after the first dose the patient had almost fully recovered. The success of this case points out the potential effectiveness of anakinra in the prevention of a pulmonary failure and the treatment of a severe intermittent polycyclic pattern of AOSD.