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Case Reports
. 2018 Dec 10:2:37.
doi: 10.1186/s41927-018-0044-5. eCollection 2018.

Positive melioidosis serology in a patient with adult onset Still's disease: a case report of a diagnostic dilemma

Harsha Anuruddhika Dissanayake  1 , Gayani Premawansa  2 , Enoka Corea  3 , Inoshi Atukorale  4
Affiliations
Case Reports

Positive melioidosis serology in a patient with adult onset Still's disease: a case report of a diagnostic dilemma

Harsha Anuruddhika Dissanayake et al. BMC Rheumatol. .

Abstract

Background: Autoimmune disorders are known to produce false positives in serological tests for infections. Aetiological association between infections and autoimmunity, increased susceptibility to infectious and autoimmune disorders with immune dysregulation and non-specific polyclonal expansion of B cells with autoimmunity may cause confusion in diagnosis and patient management. We report a patient with Adult Onset Still's Disease (AOSD) presenting with rising melioidosis antibody titres that caused diagnostic confusion.

Case presentation: A forty-nine-year-old female presented with prolonged fever, sore-throat, large joint arthritis, lymphadenopathy, hepatomegaly and transient rash. She had elevated inflammatory markers and a rising melioidosis antibody titre. The patient responded poorly to prolonged course of appropriate antimicrobials but showed rapid and sustained improvement with glucocorticoids.

Conclusion: Positive melioidosis serology could have been due to a co-infection or false positive antibody reaction due to non-specific B cell expansion or an indicator of true infection that triggered the immune dysregulation to develop AOSD.

Keywords: Adult onset Still’s disease; False positive antibodies; Melioidosis.

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Conflict of interest statement

Not applicable.Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
C-reactive protein, ferritin and anti-melioidosis antibody titres, Changes in CRP, ferritin and antibodies against melioidosis over time are illustrated. Treatment instituted are noted at the bottom
See this image and copyright information in PMC

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