Wissler–Fanconi syndrome and related diagnoses: a case report

INTRODUCTION: Wissler–Fanconi syndrome is a rare rheumatic syndrome that was first described during the 1940s in Europe. Since then, many papers have been written that cover all aspects of this syndrome, most of which are in French and German language, with only a very few in English (none of them recent). We report here a case that fulfils the criteria for Wissler–Fanconi syndrome. Under the more general descriptive umbrella of Wissler–Fanconi syndrome, our patient also fulfils the Modified Jones criteria, and the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for rheumatoid arthritis, and was interpreted by other internists and another rheumatologist as fulfilling the Yamaguchi criteria for adult onset Still’s disease. CASE PRESENTATION: A middle-aged female presented to the emergency department with shortness of breath and chest pain associated with fever, polyarthritis, and had a chronic polymorphic rash on the back and lower extremities. Blood analysis showed highly elevated inflammatory markers and rheumatoid factor. After ruling out other possible deferential diagnoses and reviewing the medical literature, the patient was diagnosed with Wissler–Fanconi syndrome. A combination of nonsteroidal anti-inflammatory drugs and steroids achieved complete remission. CONCLUSION: This case report highlights the important differential diagnosis that may be included under the nomenclature of Wissler–Fanconi syndrome (subsepsis hyperergica). Features of Wissler–Fanconi syndrome can be found in a differential diagnosis that includes true sepsis, acute rheumatic fever, rheumatoid arthritis, and adult onset Still’s disease.