A case report of successful treatment of 90° knee flexion contracture in a patient with adult-onset Still's disease.

BACKGROUND: Severe knee flexion contractures greater than 80° are rare and challenging to manage. Previous studies have demonstrated unsatisfactory clinical results after correcting these deformities because residual flexion contractures were not corrected within a short period of time. We herein report the case of a patient with adult-onset Still's disease with 90° of bilateral knee flexion contracture, which was successfully corrected by total knee arthroplasty and serial casting over a period of five weeks. CASE PRESENTATION: A 47-year-old male was admitted to our orthopedic department for bilateral knee pain and a preoperative fixed flexion contracture of 90°. A diagnosis of adult-onset Still's disease was made based on the patient's medical history of a high spiking fever, salmon-colored rash and bilateral knee and wrist pain. Bilateral total knee arthroplasty was carried out to address these deformities, but residual flexion contracture was present. Subsequently, serial casting was used to achieve full extension at four weeks after surgery. Excellent function and patient satisfaction were observed at two years of follow-up. CONCLUSION: The new protocol of total knee arthroplasty with subsequent serial casting seems to be an efficient solution for knee flexion contractures greater than 80°. This report adds to the very small number of reported cases of adult-onset Still's disease with severe knee flexion contractures and describes a patient who was successfully treated with a new protocol.

[Rare cause of acute liver failure]. / Seltene Ursache eines akuten Leberversagens.

A rare cause of acute liver failure is adult onset Still's disease (AOSD), a systemic inflammatory disorder. We present the case of a 24-year-old woman who presented with acute liver failure necessitating high urgency liver transplantation. The diagnosis of AOSD was established in accordance with the Yamaguchi classification criteria, including arthralgia, fever, sore throat, rash and hepatosplenomegaly. The early detection and therapy of AOSD can possibly avoid the development of liver failure with a poor prognosis.

Small intestine Crohn's disease presenting as fever mistaken for adult onset Still's disease.

Crohn's disease (CD) is not rare in recent years, but it is sometimes difficult to make a definite diagnosis particularly if it is in the small intestine. We report a patient with fever for 8 months whose disease was mistaken to be Adult onset Still's disease. The patient was diagnosed small intestine Crohn's disease at last by pathology. We want to emphasize that doctors should not forget small intestine Crohn's disease when encountering an unidentified feverish patient, they should not diagnose a feverish patient of Adult onset Still's disease at once. It is important to note that corticosteroids can conceal many diseases and they should not be considered lightly even if the patient is diagnosed with Adult onset Still's disease.

Delayed ascending aortic pseudoaneurysm in an adult onset Still's disease patient with previous mitral valve and aortic root replacement.

A 59-year-old female patient with adult onset Still's disease (AOSD) presented with hemoptysis and pseudoaneurysm from an aortic root vent cannulation site that was created 4 years earlier for combined mitral and aortic valve surgery. The pseudoaneurysm was successfully repaired and the patient remained well during a follow-up period of 20 months.

[Adult-onset Still's disease with liver failure requiring liver transplantation]. / Enfermedad de Still del adulto con desarrollo de insuficiencia hepática que precisa trasplante hepático.

We present the case of a 23-year-old man with fever of unknown origin, who developed acute liver failure 2 months after symptom onset, requiring an urgent liver transplantation. The diagnosis of adult-onset Still's disease was established after the reappearance of symptoms after transplantation, and high doses of corticosteroids were used to control disease activity. Subsequently, given the impossibility of tapering the steroid dose, interleukin-1 receptor blocking treatment was started with satisfactory outcome. We also review the published literature.

Formation of numerous rice bodies: an unusual finding of adult-onset Still's disease.

Adult-onset Still's disease (AOSD) is an inflammatory disorder characterized by high-spiking fever, arthritis, and an evanescent rash. The pattern of chronic arthritis is a universal feature of AOSD. However, chronic bursitis with the formation of numerous rice bodies is a very rare presentation in a patient with AOSD. To our knowledge, no case of formation of numerous rice bodies in AOSD has been reported thus far. We describe the case of a 28-year-old man with AOSD with rice bodies in his left shoulder joint.

[Arthrodesis of the wrist in inflammatory arthropathy. Effects of fusion of intracarpal joint spaces on functional results]. / Arthrodèses du poignet pour arthropathie inflammatoire. Influence de la fusion des interlignes intra-carpiens sur le résultat fonctionnel.

We retrospectively analysed 25 wrist arthrodeses performed in 23 patients because of inflammatory joint disease (21 rheumatoid arthritis, 1 case of Still's disease, 1 case of psoriatic arthritis) to assess: 1) the functional result, the position and the fusion rate; 2) the correlation between the radiographic features and the results on pain. The results were evaluated after an average of 56 months (12-121) by an observer not involved in surgery. 8 wrists were pain-free, 12 caused occasional pain, 4 caused frequent pain and 1 wrist was responsible for continuous pain at follow-up. The position of the arthrodesis was acceptable in the sagittal plane (mean extension 4.3 degrees), but with a slight ulnar tilt (mean ulnar tilt 12.8 degrees). Fusion was achieved in all cases after a mean of 8.2 weeks (5-16). All the intracarpal joints had united in only 8 cases, while the scaphotrapezo-trapezoid joint had not united in 17 cases, but fusion was spontaneously obtained in 8 cases. We identified 5 non-unions between lunatum and triquetrum, 5 non-unions between hamatum and capitatum and 3 non-unions between triquetrum and hamatum. Pain at follow-up was related to non-union of triquetro-lunate joints (p = 0.035). Wrist arthrodesis remains appropriate for severe lesions of the rheumatoid wrist in order to restore function and relieve pain.