Atypical rash in adult onset Still's disease: case report

The diagnosis of adult onset Still's disease is usually based on a symptom complex and the well-described typical rash, seen in most patients [Still's rash]. Other cutaneous manifestations of adult onset Still's disease have been reported but these are not well known. This case report describes the occurrence of an atypical skin eruption [prurigo pigmentosa] in a young female with adult onset Still's disease in the absence of the classic evanescent rash of Still's disease. The association of prurigo pigmentosa and adult onset Still's disease is extremely rare and only a single case report exists in the English literature. Therefore, we should carefully follow the clinical course of a patient in order not to overlook these atypical cutaneous manifestations of adult onset Still's disease

Adult onset still's disease and prurigo pigmentosa: an unusual association and review of literature

This study was conducted in the Department of Medicine, Department of Dermatology, Al-Adan Hospital, Ministry of Health-Kuwait. This patient was hospitalized as a case of pyrexia of unknown origin. We report atypical skin eruption in this patient who fulfilled the criteria for Adult Onset Still's Disease [AOSD] despite the absence of the typical still's rash. Skin biopsy revealed prurigo pigmentosa [PP]. To elucidate this unusual association, we searched the literature for the cutaneous manifestations of AOSD. Kahori T, et al had described PP like lesions in a patient with AOSD in addition to the typical still's rash and it is the only case report that exists in English literature. In our case, except for still's rash, all the criteria of AOSD were present, the diagnosis was made after excluding all other possible causes i.e. infectious diseases, other rheumatic diseases, vasculitis and malignant disease. The objective for reporting this case and review of literature is to shed more light on the rare dermatological disorder Prurigo Pigmentosa [PP] and its unusual association with Adult Onset Still's Disease [AOSD]. Clinicians and dermatologist must be aware of this unusual association of PP and AOSD as the diagnosis of AOSD can be made in the absence of the typical still's rash but in the presence of other atypical cutaneous manifestations including PP

Profound hyperkalemia and the electrocardiogram. Lack of correlation: a case report

We report a case of severe hyperkalemia as a result of treatment with potassium sparing diuretics, digoxin and angiotensin receptor antagonist valsartan in the presence of renal insufficiency. Inspite of a maximal serum potassium concentration of 10.3 mmol/l, only non-specific ECG changes were found. The patient survived after an uneventful dialysis. Thus severe hyperkalemia may present without typical ECG changes, and values exceeding 10.3 mmol/l may not necessarily be fatal