P137 | A perihepatic abscess presenting with characteristics of adult-onset Still’s disease

Background: Still’s Disease (SD) is an inflammatory condition associated with high fever, arthritis/arthralgia, leukocytosis, and skin rashes. Reactive arthritis arises in response to an infection within the body, typically appearing within a few weeks of the infection. Clinical case: 71-year-old male admitted for the past two weeks with remitting fever (39.5°C), accompanied by fatigue, migrating arthritis, and skin erythema. 14 months earlier he underwent laparoscopic cholecystectomy for cholelithiasis. Two months after he developed a low-grade fever with standard X-ray revealing a small pleural effusion, resolved with amoxicillin/clavulanate. On admission: T 39C, diffuse arthralgia, arthritis of the wrists, splenomegaly. Biochemical analysis: CRP 45 (nv<5mg/ml), ESR 89 (nv<10mm), leukocytosis 13,000 (nv<9,000mm³). Suspecting SD prednisone therapy (40 mg/day) was initiated resulting in a significant clinical improvement. Body CT: small pleuro-pericardial effusion, a 7.5 cm multiloculated mixed-density formation with calcifications and air-containing areas. Piperacillin/tazobactam therapy was initiated. Patient underwent laparoscopic drainage with isolation of Streptococcus a. and presence of cholesterol stones. Conclusions: The case we presented is interesting concerning the differential diagnosis. Yamaguchi diagnostic criteria were met for SD diagnosis. However, radiographic investigations identified the presence of a perihepatic abscess related to the previous cholecystectomy. Another noteworthy aspect is the delayed onset of symptoms post-surgery.