Refractory Relapsing–Remitting Adult-Onset Still’s Disease in an Adolescent Female: A Rare Case Report

Abstract

Adult-onset Still’s disease (AOSD) is a rare systemic autoinflammatory condition that presents with symptoms such as fevers that spike intermittently, a transient rash, inflammatory arthritis, and significant systemic inflammation. Relapsing–remitting disease always remains therapeutically challenging.

Case Presentation: We present the case of an 18-year-old female who has been experiencing recurrent high-grade fevers, an evanescent salmon-pink rash, and symmetrical inflammatory polyarthritis over several years. After ruling out infectious, malignant, and other autoimmune diseases, she was diagnosed with AOSD based on the Yamaguchi criteria. Despite receiving treatment with corticosteroids and conventional disease-modifying antirheumatic drugs (DMARDs), including methotrexate, she suffered from multiple relapses, indicating a polycyclic disease pattern. The introduction of biologic therapy with tocilizumab provided temporary remission. However, her flares returned during the tapering of steroids, necessitating an increase in the dosage and the use of pulse corticosteroid therapy.

Conclusion: This case report describes the relapsing–remitting nature of AOSD and emphasizes the critical need for early diagnosis and initiation of targeted biologic therapy for managing refractory cases.

Bangladesh J Medicine 2026; Vol. 37, No. 2(1): pp. 232