Co-existence of adult-onset still's disease and IgA nephropathy/Eriskin still hastaligi ve IgA nefropatisi birlikteligi

Adult-onset Still's disease (AOSD) is an acute systemic inflammatory disease with unknown etiology and pathogenesis. Fever together with skin, musculoskeletal, and rarely cardiopulmonary and reticuloendothelial system involvements are prominent findings. Renal involvement is much rarer. Herein, we report a case of a patient, who presented with classical findings of AOSD and microscopic hematuria, and was histologically diagnosed as IgA nephropathy. A twenty-four-year-old male attended to our clinic with arthralgia, fever, rash and darkening of urine color for the last two months. Physical examination was normal, except for fever of 39.3 [degrees]C, diffuse maculopapular rash and arthritis. Laboratory tests of the patient, who had macroscopic hematuria, revealed leukocytosis with neutrophil predominance and elevated erythrocyte sedimentation rate, CRP and ferritin (>2000 ng/ml) levels. ANCA, ANA and RF were negative. After excluding diseases associated with systemic vasculitis, he was diagnosed as AOSD according to the above-mentioned clinical and laboratory findings and steroid treatment was initiated. Renal biopsy performed due to persistent hematuria and proteinuria was consistent with IgA nephropathy. Renal involvement in AOSD is usually in the form of microscopic hematuria and transient proteinuria. Persistant macroscopic hematuria in spite of treatment is not expected in AOSD. In this situation, other co-existing renal diseases should be sought, and renal biopsy should be done when necessary. (The Medical Bulletin of Haseki 2010; 48: 92-4) Key Words: Adult-onset Still's disease, hematuria, IgA nephropathy Eriskin Still hastaligi (ESH) etiyoloji ve patogenezi bilinmeyen akut baslangicli sistemik insamatuvar bir hastaliktir. Atesle beraber cilt, kas-iskelet sistemi, nadiren kardiyopulmoner ve retikuloendotelyal sistem bulgulari on plandadir. Bobrek tutulumu ise cok nadirdir. Burada makroskopik hematurinin yani sira ESH'nin klasik bulgulariyla basvuran ve histopatolojik olarak IgA nefropatisi tani si konulan bir olgu sunulmustur. Yirmi dort yasinda erkek hasta iki aydir devam eden eklem agrisi, ates, idrar renginde koyulasma ve dokuntu sikayetleriyle basvurdu. 39.3 [degrees]C atesi, tasikardisi olan hastanin fizik muayenesinde tum vucutta yaygin makulopapuler dokuntu ve artrit disinda bir ozellik yoktu. Makroskopik hematurisi olan hastanin laboratuar incelemelerinde notrofil hakimiyetli lokositoz, yukselmis eritrosit sedimantasyon hizi, CRP ve ferritin (