Persistent pruritic skin rashes masquerading sulfasalazine sensitivity in a newly diagnosed Adult-Onset Still’s Disease (AOSD)

Adult-Onset Still’s Disease (AOSD) is a rare clinical entity with unknown etiology characterized by arthritis, fever, evanescent rash and other systemic presentations. This report describes a 30-year-old woman presented first with classic picture of rheumatoid arthritis since six years ago on oral prednisolone, sulfasalazine and methotrexate and was recently admitted with refractory sore throat, fever, arthritis, persistent pruritic rash and leukocytosis. Adverse drug reactions to sulfasalazine was the working clinical diagnosis. Discontinuation of sulfasalazine did not show any clinical benefit. The patient responded fully to combine pulsed methylprednisolone and higher doses of oral prednisolone and systemic disease-modifying anti-rheumatic drugs.