A 33-year-old woman with no relevant morbid history consulted for several days of fever, general malaise and sensitivity to cervical palpation.
On admission she was found with tachycardia, painful, with presence of generalized maculopapular rash and painful swelling of the thyroid gland.
Initial laboratory tests showed normal blood count and liver tests and tests with hyperthyroid pattern (TSH 0.01 IU/mL and free T4 120 ug/%).
The diagnostic possibility of acute thyroiditis was established and treatment with beta oral blockade was started, achieving tachycardia control but with persistent fever.
An extensive study was performed that was negative for infections, abnormal liver tests (GOT 1,200 U/L and GPT 900 U/L) and intensely positive antithyroid receptor antibodies (TRAB) were detected.
The imaging study with CT showed diffuse goiter and axillary lymphadenopathy and no evidence of malignancy or infection was found.
The patient had a rapid onset and progressive loss of function explained by pancythemia (9 g%, leukocytes 2,300/uL, platelets 65,000/uL), elevated ferritin (12,300 IU/L) and progressive deterioration.
Biopsies were taken to clarify the cause of multiorgan involvement.
Skin biopsy showed spongy dermatitis compatible with Still's disease.
Bone marrow biopsy showed reactive hyperplasia and lymph node biopsy showed nonspecific lymphadenitis.
A second ferritin measurement was performed, which resulted in 34,000 IU/L. The possible diagnosis of HPS was established with the HLH 04 protocol.
After starting CMT, the patient presented symptomatic improvement with normalization of ferritin.
After 18 months of treatment, the patient has had a favorable evolution achieving a good quality of life, with remission of liver alterations and normalization of hematopoiesis.
You are currently receiving satisfactory treatment for your Graves’ disease.
