Abstract
BackgroundAutoimmune disorders are known to produce false positives in serological tests for infections. Aetiological association between infections and autoimmunity, increased susceptibility to infectious and autoimmune disorders with immune dysregulation and non-specific polyclonal expansion of B cells with autoimmunity may cause confusion in diagnosis and patient management. We report a patient with Adult Onset Still’s Disease (AOSD) presenting with rising melioidosis antibody titres that caused diagnostic confusion.Case presentationA forty-nine-year-old female presented with prolonged fever, sore-throat, large joint arthritis, lymphadenopathy, hepatomegaly and transient rash. She had elevated inflammatory markers and a rising melioidosis antibody titre. The patient responded poorly to prolonged course of appropriate antimicrobials but showed rapid and sustained improvement with glucocorticoids.ConclusionPositive melioidosis serology could have been due to a co-infection or false positive antibody reaction due to non-specific B cell expansion or an indicator of true infection that triggered the immune dysregulation to develop AOSD.
Highlights
Autoimmune disorders are known to produce false positives in serological tests for infections
Positive melioidosis serology could have been due to a co-infection or false positive antibody reaction due to non-specific B cell expansion or an indicator of true infection that triggered the immune dysregulation to develop Adult Onset Still’s Disease (AOSD)
We report a patient with adult onset Still’s disease (AOSD) who developed antibodies against B. pseudomallei, a phenomenon not described previously
Summary
Melioidosis is an emerging infection in the tropics caused by Burkholderia pseudomallei. Case presentation A forty-nine-year-old female from a suburban community in Sri Lanka presented with insidious high grade intermittent fever with chills and rigors for 2 months She experienced one to two febrile episodes daily with complete defervescence in between. Serum protein electrophoresis showed polyclonal gamma-globulinaemia and reduced albumin fraction As she had been exposed to flood water 2 weeks prior to symptom onset (compatible with incubation period of 1–3 weeks) and several cases of melioidosis had been reported in her residential area, antibodies against Burkholderia pseudomallei were tested. It turned positive (1:640, indirect haemagglutination) and titre continued to rise over time (Fig. 1). During the course of her illness the patient did not develop Macrophage Activation Syndrome, a serious complication of AOSD
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