CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Adult-Onset Still's Disease Presenting with Aseptic Meningitis: A Case Report
Provisionally accepted
- 1Department of Rheumatology, Liuzhou People’s Hospital, Guangxi Medical University, Liuzhou,, Guangxi Zhuang Autonomous Region,, China
- 2Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401,, Taiwan
- 3Chung Shan Medical University College of Medicine, Taichung City, Taiwan
- 4Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital,, taichung, Taiwan
- 5Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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Adult-onset Still's disease (AOSD) is a systemic autoinflammatoryimmune inflammatory disorder characterized by high spiking fever, evanescent rash, arthritis, sore throat, and lymphadenopathy. The pathogenesis of AOSD remains unclear. Neurological involvement in AOSD is exceedingly uncommon. This case report describes an atypical rare presentation of AOSD adult-onset Still's disease complicated by aseptic meningitis, where the true rarity lies in the unusually severe neurological involvement and associated complications, including empty sella.. A 56-year-old female was admitted with a one-year history of recurrent high-grade fever, fatigue, accompanied by seizures and episode of altered consciousness lasting for over 17 hours. During the course of hospitalization, she exhibited polyarticular swelling and pain, seizures and impaired consciousness. A 56-year-old female patient was admitted with a one-year history of recurrent fever and fatigue, along with seizures and altered consciousness lasting for over 17 hours. Clinically, she presented with recurrent high-grade fever, fatigue, polyarticular swelling and pain, seizures, and impaired consciousness. Laboratory analysis revealed leukocytosis and markedly elevated serum ferritin levels. Brain magnetic resonance imaging (MRI) showed diffuse leptomeningeal enhancement. Infectious, demyelinating, and other etiologies were excluded based on CSF analysis and other evaluations. A diagnosis of aseptic meningitis secondary to AOSD was made. The patient was treated with corticosteroids, cyclosporine, tocilizumab, intrathecal dexamethasone, and methotrexate, resulting in marked clinical improvement. This case highlights the importance of recognizing uncommonrare neurological manifestations of AOSD and underscores that severe complications such as empty sella may occur and require the necessity of prompt recognition and treatment. to improve outcomes.
Keywords: Adult-onset Still's disease, Autoimmune inflammatory disorder, Case-report, Japanese Yamaguchi criteria, tocilizumab
Received: 06 Jul 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Li, Ker, Liao, Liu and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Amy Ker
Yuan Liu
James Cheng-Chung Wei
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