Jaimie Mittal, Christopher Estiverne, Neil Kothari,Alluru Reddi*

Fever is defined as an elevation in core body temperature. It is a common presentation in patients with infection, and is associated with increased heart rate.In certain infectious conditions, however, there is dissociation between temperature and heart rate. This pulse-temperature deficit is called relative bradycardia, which is referred to as Faget's sign. Here we present a case of 45-year-old man with West Nile virus and a temperature of 1030 F with a heart rate of 66 beats per minute. With the case discussion, we provide a review of various causes of fever that are associated with bradycardia. In certain clinical situations, relative bradycardia should be used as a vital clinical clue to narrow down not only the differential diagnosis but also to provide guidance for appropriate management.

Cite this Article: Mittal J, Estiverne C, Kothari N, Reddi A. Fever and Relative Bradycardia: A Case Presentation and Review of the Literature. Int J Case Rep Short Rev. 2015;1(1): 004-008.

Published: 17 December, 2015

Prabhakaran Gopalakrishnan*, Smita Subramaniam, Asha Thomas, Andrey Manov

Adult onset Still's disease is a rare inflammatory disorder characterized by daily spiking fevers, arthritis and an evanescent rash, typically affecting young adults. We report a case of Adult onset Still's disease presenting as recurrent fever complicated by acute respiratory distress syndrome, an uncommon presentation which has been infrequently described in literature.

A 33 year old Hispanic male presented with recurrent daily fevers, sore throat and lymphadenopathy. Comprehensive diagnostic evaluation including lymph node biopsy and bone marrow biopsy was negative for infectious causes. His clinical course was complicated by acute respiratory distress syndrome. Adult onset Still's disease was diagnosed based on clinical and laboratory findings. Patient was started on steroids and responded well with resolution of his respiratory failure and fever.

Adult onset Still's disease is a rare febrile disorder primarily affecting young patients with varied presentations. Diagnosis is clinical and could be easily missed unless the evaluating physician is aware of both the typical as well as atypical presentations such as acute respiratory distress syndrome, as was found in our patient. Delayed diagnosis or misdiagnosis may lead to recurrent and prolonged hospitalizations in addition to costly and potentially harmful diagnostic workup and therapeutic interventions.

Cite this Article: Gopalakrishnan P, Subramaniam S, Thomas A, Manov A. Adult Onset Still's Disease Presenting as Recurrent Fever with ARDS: A Case Report. Int J Case Rep Short Rev. 2015;1(1): 001-003.

Published: 22 October, 2015