Nikhil Prasad Fact checked by:Thailand Medical News Team Apr 24, 2025 2 hours, 12 minutes ago
Medical News: A Mysterious Case After COVID Infection
Doctors in Croatia have reported a rare but serious condition in a man who developed adult-onset Still’s disease (AOSD) shortly after recovering from a mild case of COVID-19. The disease is an inflammatory disorder that is extremely uncommon in adults and can cause high fever, rashes, and painful joint swelling.
COVID-19 Virus Can Trigger Still’s Disease in Adults
The medical team included Dr Tina Zavidic from the University of Rijeka and Istrian Health Centers in Pazin, Dr Ema Dejhalla from the Medical Centre for Occupational Health Rijeka, Dr Ana Lesac Brizic from the University of Rijeka and Health Center of Primorje–Gorski Kotar County, and Dr Branislava Popovic from the University of Rijeka and her private clinic in Rijeka.
This
Medical News report outlines the case of a 56-year-old man with no previous history of autoimmune or serious inflammatory illness. He initially presented with a mild fever after COVID-19, but within a week, developed severe sore throat, a widespread pinkish rash, joint pain, and swelling in his ankles and wrists. Walking became difficult. Tests showed signs of liver inflammation, a dangerously high ferritin level (8465 µg/L), and elevated inflammatory markers.
Still Disease and Its Overlap with COVID
Still disease is an immune-related illness characterized by recurring high fevers, arthritis-like joint pain, liver problems, and a distinctive salmon-colored rash. It is rare in adults and is often difficult to diagnose due to its similarities to infections like COVID-19. Doctors used the Yamaguchi criteria—a specific diagnostic checklist for AOSD—to confirm the diagnosis. The patient met several major and minor criteria, including high fever lasting more than a week, joint pain lasting over two weeks, elevated white blood cells, abnormal liver enzymes, and the classic rash.
Further lab work and imaging showed inflammation in the joints, liver enlargement, and some changes in the heart. Importantly, a positive PCR test confirmed recent SARS-CoV-2 infection, implicating it as a likely trigger for the inflammatory attack.
Treatment and Recovery
The patient was initially given intravenous antibiotics and anti-inflammatory medication, followed by a regimen of high-dose steroids (methylprednisolone) and immunosuppressants such as cyclosporine. His symptoms gradually improved over two weeks. He was discharged on a combination of oral steroids and cyclosporine and monitored closely as the steroid dosage was tapered down.
Over the next few months, the man experienced mild relapses of the rash but did not develop any severe recurrence of fever or joint pain. Steroids were eventually discontinued after three months, while cyclosporine therapy continued for two years with dose adjustments.
COVID-19 and the Immune System Time Bomb
Researchers believe that SARS-CoV-2 may act as a trigger for AOSD by disturbing the immune system. The virus
activates inflammatory pathways such as IL-1 and IL-6, which are also heavily involved in Still disease. This overlap may lead to a “cytokine storm,” a dangerous immune response that causes excessive inflammation. Doctors now classify AOSD, macrophage activation syndrome, and severe COVID cases under a group known as “hyperferritinemic syndromes,” all of which feature skyrocketing ferritin levels and a risk of multi-organ failure.
Why This Case Matters
This case underscores the importance of paying attention to lingering or unusual symptoms after COVID-19 infection. While most people recover with no complications, some may develop hidden autoimmune or inflammatory conditions weeks or even months later. The similarity in symptoms and immune markers between AOSD and COVID-19 means doctors need to remain alert and consider a wider range of diagnoses, especially in patients with persistent fever, joint pain, and elevated ferritin.
Conclusion
SARS-CoV-2 may do far more damage than just temporary respiratory illness. It can disturb the immune system in ways that trigger dangerous long-term diseases such as adult-onset Still’s disease. This case highlights the urgent need for more research into the autoimmune aftermath of COVID-19 and supports calls for careful patient monitoring even after mild infections. Early diagnosis and the right treatment can drastically reduce the chances of long-term complications and help patients return to normal life. Physicians are encouraged to look beyond the obvious and recognize signs of emerging inflammatory or autoimmune conditions that may follow in the wake of COVID-19.
The study findings were published in the peer reviewed journal: ACR Open Rheumatology.
https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr2.70042
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https://www.thailandmedical.news/news/london-doctors-warn-that-covid-19-vaccines-can-cause-adult-onset-still-s-disease
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https://www.thailandmedical.news/news/breaking-news-scientists-from-baltimore-warns-that-sars-cov-2-infections-or-covid-19-va
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