Adult onset still’s disease masquerading as acute coronary syndrome

Abstract

Adult onset still’s disease (AOSD) is a rare inflammatory disorder characterized by high fevers, arthralgia, salmon rash and leukocytosis. It is a diagnosis of exclusion and popularly diagnosed by the Yamaguchi criteria. Cardiac involvement in AOSD causing myocarditis is seldom seen. Echocardiography is an important measure of cardiac manifestation, but a more characteristic confirmation is obtained by the cardiac MRI. It is an increasingly recognized noninvasive alternative to the gold standard endomyocardial biopsy. In this case, mid myocardial enhancement in the absence of left ventricular dysfunction was consistent with a diagnosis of myocarditis in AOSD. The delay in diagnosis was caused by AOSD masquerading as acute coronary syndrome. This case highlights the importance of early recognition of myocarditis in an atypical presentation of AOSD which results in early immunomodulatory therapy and an improved clinical outcome.