case_images: PMC9187476_01
case_images: Adult onset Still disease, skin biopsy with multiple individual dyskeratotic keratinocytes in the upper epidermal layers (thin arrows) and perivascular neutrophilic inflammatory infiltrate (thick arrow) (H&E X100).
case_images: CRII2022-1653683.001.jpg
case_images: PMC9187476_01_CRII2022-1653683.001.jpg
case_images: fig1
case_images: Punch biopsy of the skin was done in coordination with the dermatology department in day care, and it revealed epidermal dyskeratotic keratinocytes mainly in the upper layers of the epidermis and focally in the stratum corneum (Figure 1).
case_images: Adult onset Still disease, (A) skin biopsy with (a) multiple individual dyskeratotic keratinocytes in the upper epidermal layers (thin arrows) and (b) perivascular neutrophilic inflammatory infiltrate (thick arrow) (H&E X400).
case_images: CRII2022-1653683.002.jpg
case_images: PMC9187476_01_CRII2022-1653683.002.jpg
case_images: fig2
case_images: There was a superficial perivascular, periadnexal, and interstitial inflammatory infiltrate rich in neutrophils and few lymphocytes (Figure 2).
case_images: Dermatopathic lymphadenopathy. (a) Subcapsular nodular showing palely stained area in the paracortical region. Hyperplastic lymphoid follicles are also present (H&E X100). (b) Numerous pigment-containing histiocytes were present in the pale stained area (H&E X400).
case_images: CRII2022-1653683.003.jpg
case_images: PMC9187476_01_CRII2022-1653683.003.jpg
case_images: fig3
case_images: To rule out the possibility of lymphoma, a lymph node biopsy was performed, which revealed a preserved normal lymph node architecture, reactive lymphoid follicles, and marked paracortical expansion with irregular pale areas (Figure 3) consisting of numerous foamy histiocytes with brown melanin pigment, interdigitating dendritic cells, and Langerhans cells mixed with small lymphocytes.