Vol.22 No.5

Case Report

A case of adult-onset Still’s disease (AOSD)-like manifestations abruptly developing during confirmation of a diagnosis of metastatic papillary thyroid carcinoma

Authors

Ryo Inoue1,2 , Takashi Kato1 , Fae Kim1,2 , Ichiro Mizushima1,2 , Tomomi Murata3 , Hiroshi Yoshino3 , Mitsuhiro Kawano2 , Masakazu Yamagishi4

  • Division of Rheumatology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi, Kanazawa, 920-8530, Japan
  • Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
  • Division of Endocrinologic Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi, Kanazawa, 920-8530, Japan
  • Division of Cardiology, Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
Received:

29 August 2011

Accepted:

22 December 2011

Published online:

24 January 2012

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Abstract

A 68-year-old Japanese man was admitted to our hospital suffering from abrupt onset of high fever accompanied by arthralgia, myalgia, sore throat, macular eruption, and liver dysfunction. Six months before the onset of these manifestations, 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (18FFDG PET/CT) had detected, unexpectedly, three calcified thyroid lesions without 18F-FDG uptake. Two months before the onset of the present manifestations, ultrasonography-guided fine-needle aspiration had led to a diagnosis of papillary thyroid carcinoma (PTC). Soon after the occurrence of the rheumatic manifestations, a subsequent 18F-FDG PET/CT scan showed not only the three thyroid lesions, the same as those in the previous scan, but also 18FFDG uptake in the thyroid lesion. A diagnosis of adultonset Still’s disease (AOSD)-like manifestations associated with PTC was made, and treatment with 40 mg/day of prednisolone (PSL) resolved the symptoms promptly. PSL was gradually tapered, without recurrence of the (AOSD)-like manifestations. Five months after the initiation of treatment with PSL, total thyroidectomy, followed by 131I thyroid ablation treatment, was performed while the patient was on a PSL dose of 18 mg/day. Seven months after the thyroidectomy, the dose of PSL was tapered to 2 mg/day, and neither the AOSD-like manifestations nor the PTC relapsed. On confirming a diagnosis of AOSD, it may be necessary to consider the presence of an associated malignancy, including solid tumors such as PTC.

Key words

Adult-onset Still’s disease (AOSD) - Papillary thyroid carcinoma - Paraneoplastic syndrome - PET/CT - 18F-FDG