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AB0030 Biopsy findings in adult-onset still disease
  1. CA Montilla1,
  2. E Cuevas2,
  3. J Abraham-Simón2,
  4. CM González1,
  5. FJ López-Longo1,
  6. I Monteagudo1,
  7. L Carreño1,
  8. J Alcocer-Varela2,
  9. D Alarcón-Segovia2
  1. 1Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  2. 2Immunology and Rheumatology, Instituto Nacional de Nutrición Salvador de Zubirán, Mexico DF, Mexico

Abstract

Background The differential diagnosis of adult-onset Still disease involves cancer, infections and other rheumatic diseases. Thus, differential diagnosis frequently requires the performance of biopsies. However, there are not many reports about histological findings in these patients.

Objectives To describe biopsy findings in patients with adult-onset Still disease.

Methods We have studied biopsies from 35 patients with adult-onset Still disease performed between April of 1979 and December of 1999 in Salvador Zubirán Nutrition Institute.

Results 60% of all patients adult-onset Still disease underwent a biopsy. In lymphatic ganglions, which constitute the most frequent biopsy, the main finding is the loss of structure with lymphoid follicles of variable size and a sinusal part widened with arteries with hyalines and gross walls. In some samples, areas of necrosis and haemorrhage were found. In the liver appeared focal infiltrates of polymorphonuclear leukocytes in hepatic lobulille and lymphoplasmocitaries accumulates in porta spaces. In some patients an opening of sinusal and Disse spaces with focal necrosis area was described. In the spleen, polymorphonuclears were identified in red pulp, with a moderate amount of plasmatic cells and eosinophils, and an important widening of arterial walls. White pulp did not showed any disturbance. In the skin, it was demonstrated the presence of polymorphonuclears and lymphocytes infiltrates with a perivascular and perianexial predominance. Paraqueratosis areas were also described. Perivascular inflammatories infiltrates in the muscle with areas of necrosis were described. In the lung, a broadening of alveolar walls because of an inflammatory infiltrate composed by polymorphonuclears and lymphocytes was described. Areas of haemorrhage were also described.

Conclusion We have not found any characteristic histological finding of Still disease in the adult. In most of the biopsies predominate non-specific inflammatories infiltrates.

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