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Adult-onset Still’s disease (AOSD) is a multi-system, inflammatory disease that presents with acute fevers, arthritis or arthralgia, and a evanescent maculopapular rash, mostly occurring with myalgia, sore throat, splenomegaly, lymphadenopathy, raised C-reactive protein (CRP), serum ferritin, and neutrophilic leukocytosis. This is a case report of a 51-year-old female who came with pruritic plaques on her neck, chest, shoulders, upper arms, thighs, and lower back along with fever and arthritis. Her initial lab work showed borderline low C4, positive antinuclear antibody (ANA), and a CRP of 14 mg/dl (that was later increased to 281 mg/dl), microscopic hematuria with +1 protein on urinalysis with a creatinine of 1.3 mg/dl, WBC of 23.5x109/L mildly elevated liver function tests, brain natriuretic peptide (BNP) of 480 mg/dl, and high troponin of 0.130. In this case, we are highlighting the atypical presentation of rash in Adult-onset Still’s disease.
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