Background Adult-onset Still's disease (AOSD) is an acute and systemic inflammatory disorder that is characterized by high spiking fever, evanescent rash, arthralgia/arthritis and hyperferritinemia. However, recent reports showed that not only typical evanescent salmon-colored rash but also atypical skin lesions, persistent pruritic papules and plaques, could be associated with AOSD.
Objectives The aim of this study is to assess the clinical significance of dyskeratotic cells in skin lesions of Japanese patients with AOSD.
Methods We retrospectively assessed clinical and histological findings of skin lesions including persistent pruritic skin lesions in Japanese patients with AOSD (n=12). Moreover, we compared serological and histological finding of AOSD with that of dermatomyositis (DM) (n=6), drug eruptions (DE) (n=6), and Graft versus Host disease (GVHD) (n=6).
Results AOSD with persistent pruritic skin lesions (n=7) histologically showed dyskeratotic cells only in upper layer of epidermis and horny layer without intraepidermal infiltrations of inflammatory cells. These dyskeratotic cells were positive by TUNEL and single stranded DNA (ssDNA) stainings, suggesting apoptotic cells. AOSD with evanescent rash (n=5) histologically showed no dyskeratosis. On the other side, the pathological findings of DM (n=6), DE (n=6) and GVHD (n=6) had dyskeratotic cells in all layers of epidermis with inflammatory cells infiltrations. Notably, AOSD with dyskeratosis (n=7) had significant higher levels of serum IL-18 (74,300∼307,000 pg/ml) than AOSD without dyskeratosis (n=5).
Conclusions AOSD with persistent pruritic skin lesions is characterized and specific by prominent epidermal apoptosis, especially involving the upper layers. Therefore, it could play a pivotal role to recognize the atypical skin lesions of AOSD for correct early diagnosis. Finally, the high levels of serum IL-18 might be related with epidermal apoptosis of keratinocyte in AOSD.
Disclosure of Interest None declared
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