Clinical Utility of MBDA Panel in the Management of Adult Onset Still’s Disease

BACKGROUND: Adult Onset Still’s disease (AOSD) carries an expansive presentation – typically featuring a triad of fevers, myalgia/arthralgia, and a rash – which can be mistaken for infectious or malignant etiology. As such, the role of reliable biomarkers becomes critical in the diagnosis and management of AOSD. The employment of MBDA panel may be of clinical utility in AOSD management, as we describe two cases where its application drives treatment plan. METHODS: We describe two cases where application of MBDA panel – such as Vectra DA –assisted with disease management. RESULTS: Case 1 features a 68-year-old male who presented with recurrent fevers, malaise, and a rash for three weeks. He was found to have an elevated ferritin level (15,599 ng/mL) with elevated acute phase reactants, consistent with AOSD. Vectra DA score was 77 at time of diagnosis. After treatment (see table), repeat Vectra DA at follow-up was 15. Case 2 features a 25-year-old female with history of juvenile idiopathic arthritis (then inactive) who presented with fevers, malaise, and rash. She was found to have an elevated ferritin level (321 ng/mL) with elevated acute phase reactants, also consistent with AOSD. Her Vectra DA score was 80 at peak of symptoms. She underwent appropriate treatment (see table), and repeat Vectra DA at follow-up was 17. CONCLUSION: A deeper consideration should be placed on the value of MBDA as a monitoring tool in the management of AOSD, specifically when pertaining to patient’s responsiveness to therapies.