CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
This article is part of the Research TopicCase Reports in Autoimmune and Autoinflammatory Disorders: Volume IIView all 49 articles
Flagellate Eruption of Adult-onset Still disease in an Afro-Caribbean Woman: Highlighting Atypical Cutaneous Disease in Richly Pigmented Skin
Provisionally accepted
- 1The University Hospital of the West Indies, Mona, Jamaica
- 2University of the West Indies, Mona, Kingston, Jamaica
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Adult-onset Still disease (AOSD) is an uncommon autoinflammatory disorder characterized by high spiking fevers, arthralgia, and, classically a transient, salmon-colored rash. Atypical cutaneous variants, such as persistent erythematous papules and plaques often arranged in a flagellate pattern, are increasingly reported; however, few cases illustrate this morphology in individuals with richly pigmented skin. We report a 70-year-old Afro-Caribbean woman (Fitzpatrick skin type VI) with persistent high-grade fevers, polyarthritis and diarrhea of unknown origin which persisted despite multiple courses of antibiotics. Laboratory evaluation revealed leukocytosis and transaminitis. Dermatology was consulted for a cutaneous eruption present for three weeks prior to hospitalization. Examination revealed subtle red-brown papules, plaques and patches on the trunk and extremities, some in a flagellate arrangement. Skin biopsy demonstrated hyperkeratosis, individually necrotic keratinocytes in the upper epidermis and a perivascular neutrophilic infiltrate characteristic of the atypical eruption of AOSD. Further blood work confirmed marked hyperferritinemia. Treatment with systemic and topical corticosteroids resulted in improvement. This case underscores the importance of recognizing atypical cutaneous variants of AOSD in persons with richly pigmented skin to prevent diagnostic delay and improve clinical outcomes.
Keywords: Adult-Onset Still disease1, Atypical Still disease6, Black skin5, Flagellate2, Persistent pruritic papules and plaques3, Skin of color4
Received: 28 Oct 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Gomes, Facey, Morris and Ho. 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: Jonathan D Ho
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