First case report- Far Eastern Scarlet Fever (FESLF) associated with Still's disease in adults

Öz

Yersiniosis is a rare and sporadic infection that is most transmitted through raw or undercooked pork products. It may present clinically with arthritis, pharyngitis, hepatitis, persistent fever, abdominal pain, mesenteric lymphadenitis, or symptoms mimicking appendicitis [1;2]. Although it is considered a sporadic infection, difficulties in culturing the organism, its high genetic similarity (64%) with closely related species (Yersinia pestis, Yersinia enterocolitica), cross-reactivity of O:9 serovars with Brucellosis, and variability in clinical presentation can lead to delays in diagnosis [3;4]. Yersinia pseudotuberculosis produces a superantigen called YPM (Y. Pseudotuberculosis-derived mitogen), which plays a key role in the pathogenesis of Far East Scarlet-Like Fever (FESLF), causing rapid proliferation of T lymphocytes and toxic shock syndrome [1]. Therefore, it tends to have a more severe clinical course compared to other forms of yersiniosis. Mortality rates range between 11% and 75% [5;6].

In 1984, R. Colebunders and colleagues reported a case of Still’s disease associated with Yersinia enterocolitica [7]. There has been no previously reported clinical case linking Yersinia pseudotuberculosis with Still’s disease. The clinical case we present demonstrates that Yersinia pseudotuberculosis may also be associated with Still’s disease. In the presented clinical case, a diagnosis of Still’s disease was established in a 19-year-old patient with confirmed Y. pseudotuberculosis infection, due to an inadequate therapeutic response, followed by clinical remission.