Acute heart failure as a form of relapse in a patient with adult-onset Still disease

Laboratory tests at admission were as follows: hematocrit, 32%; hemoglobin, 10 g/dL; white blood cells count, 17 000/mm3 (neutrophils, 86%; basophils, 0.1%; eosinophils, 1.2%; lymphocytes, 8.8%; monocytes, 4%); platelets, 301 000/mm3; blood urea nitrogen, 40 mg/dL; creatinine, 0.8 mg/dL; plasma glucose, 92 mg/dL; sodium, 132 mEq/L; potassium, 4.2 mEq/L; magnessium, 1.9 mEq/L; creatine kinase, 390; creatine kinase-MB, 30 U/L; troponin T, 66 ng/L; aspartate aminotransferase, 169 U/L; alanine transaminase, 330 U/L; total bilirubin, 0.91 mg/dL; total proteins, 5.5 g/dL; alkaline phosphatase, 159 U/L; Ca2+, 7.8 mg/dL; erythrocyte sedimentation rate, 82 mm; polymerase chain reaction, 19 U/L; ferritin, 1650 ng/mL; lactate dehydrogenase, 857 U/L; and thyroid hormones, within normal ranges. Color-Doppler echocardiography showed mild left ventricular dilation with severe ventricular dysfunction, ejection fraction of 30%, akinesia of the inferior, inferoseptal and inferolateral segments at the midlevel and basal level and hypokinesia of the remaining segments, moderate to severe mitral regurgitation due to mitral valve tenting, mild right ventricular dysfunction, and systolic pulmonary artery pressure of 50 mm Hg.