P137 | A perihepatic abscess presenting with characteristics of adult-onset Still’s disease
V. Spagnuolo1, F. La Rosa2, G. La Rosa1, M. Maletta1, B. Napolitano3, V. Napolitano4, M. Pulicanò5, A.D. Ruffolo6, M. Scarpelli1, M. Balsano1 | 1Unit of Internal Medicine, AO of Cosenza, Rogliano (CS), 2Medical Student, “Alma Mater” University of Bologna, 3Graduate School of Medical Oncology Unit, “Careggi” Hospital, University of Florence, 4Graduate School of Radiology, University of Turin, 5Medical Student, “Mater Domini” Hospital, University of Catanzaro, 6Geriatric Unit, “San Giovanni e Paolo” Hospital, Venice, Italy
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Background: Still’s Disease (SD) is an inflammatory condition associated with high fever, arthritis/arthralgia, leukocytosis, and skin rashes. Reactive arthritis arises in response to an infection within the body, typically appearing within a few weeks of the infection.
Clinical case: 71-year-old male admitted for the past two weeks with remitting fever (39.5°C), accompanied by fatigue, migrating arthritis, and skin erythema. 14 months earlier he underwent laparoscopic cholecystectomy for cholelithiasis. Two months after he developed a low-grade fever with standard X-ray revealing a small pleural effusion, resolved with amoxicillin/clavulanate. On admission: T 39C, diffuse arthralgia, arthritis of the wrists, splenomegaly. Biochemical analysis: CRP 45 (nv<5mg/ml), ESR 89 (nv<10mm), leukocytosis 13,000 (nv<9,000mm³). Suspecting SD prednisone therapy (40 mg/day) was initiated resulting in a significant clinical improvement. Body CT: small pleuro-pericardial effusion, a 7.5 cm multiloculated mixed-density formation with calcifications and air-containing areas. Piperacillin/tazobactam therapy was initiated. Patient underwent laparoscopic drainage with isolation of Streptococcus a. and presence of cholesterol stones.
Conclusions: The case we presented is interesting concerning the differential diagnosis. Yamaguchi diagnostic criteria were met for SD diagnosis. However, radiographic investigations identified the presence of a perihepatic abscess related to the previous cholecystectomy. Another noteworthy aspect is the delayed onset of symptoms post-surgery.
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