Urticaria as a cutaneous sign of adult-onset Still's disease

Background. the cardinal signs and symptoms of adult-onset Still's disease (AOSD) include periodic fever, arthralgia and arthritis, lymphadenopathy, hepatosplenomegaly, an evanescent rash accompanied by neutrophilic granulocytosis, and a negative rheumatoid factor and antinuclear antibody test.Objective To alert clinicians and dermatologists to internal diseases such as AOSD when assisting patients with urticarial eruptions and systemic symptoms.Methods: A case report of a 52-year-old white woman who received conventional therapy for urticaria for 3 years, with no improvement. Following this period, a diagnosis of AOSD was performed based on the presence of systemic symptoms.Results: the inflammatory activity markers decreased by the second month of methotrexate therapy; however, the cutaneous lesions failed to disappear. Thalidomide was initiated, and total improvement of the cutaneous lesions was observed after 2 weeks.Conclusion: Urticarial rash is an uncommon presentation of AOSD, and clinicians must be alert to the possibility of a mis-diagnosis in these cases.Fac Med ABC, Dept Dermatol, Allergy Unit, Santo Andre, BrazilUniv São Paulo, Fac Med, LIM 53 Hosp Clin, São Paulo, SP, BrazilFac Med ABC, Dept Rheumatol, Dept Pathol, Santo Andre, BrazilUniversidade Federal de São Paulo, Dept Pathol, São Paulo, BrazilHosp Servidor Publ Municipal, Dermatol Unit, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, São Paulo, BrazilWeb of Scienc