Nasal septal perforation in adult Still's disease.

BACKGROUND

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder characterized by fever, rash, arthritis, and pharyngitis. Ear, nose, and throat (ENT) complications beyond pharyngitis are uncommon.

CASE PRESENTATION: A 31-year-old female presented with fever, sore throat, maculopapular rash, and arthritis. Laboratory findings revealed elevated inflammatory markers, hyperferritinemia, and leukocytosis. After extensive exclusion of infectious and autoimmune causes, AOSD was diagnosed, and treatment with corticosteroids and methotrexate was initiated. Clinical symptoms improved within a week. However, one month later, the patient developed nasal bleeding and crusting. ENT examination revealed anterior nasal septal perforation. Known causes of septal perforation, including infection, trauma, intranasal drug use, and vasoconstrictor sprays, were excluded.

CONCLUSION

This case highlights nasal septal perforation as a rare and possibly underrecognized complication of AOSD. Clinicians should consider ENT evaluation during both active disease and follow-up periods.