Jornal de relatos de casos clínicos

Electroconvulsive Therapy as a Potential Trigger of Adult Onset Still’s Disease

Abstract

Rauber C, Ruping FM, Blank N and Merle U

Introduction: Adult onset Still’s disease (AOSD) is an inflammatory disorder of unknown etiology. Macrophage activation syndrome (MAS) is a complication of AOSD and may present with multiorgan failure including cerebral involvement.

Clinical presentation: We describe a 43-year-old female patient with major depression treated with electroconvulsive therapy (ECT). She presented with febrile pharyngitis, arthralgia, rashes, lymphadenopathy, hepatosplenomegaly, liver failure and aseptic meningitis. Elevated serum ferritin and negative blood cultures were consistent with the diagnosis of AOSD complicated by MAS. The patient was treated with corticosteroids and anakinra and recovered rapidly.

Conclusion: The case highlights aseptic meningitis, depression and multiorgan failure as a feature of AOSD/ MAS possibly triggered by ECT. Anakinra is an effective treatment in severe MAS.