A 40-year-old female is admitted with a 3-week history of daily fever accompanied by a non-pruritic skin
eruption. She was initially seen at a walk-in clinic 5 weeks ago for cough and given a 7-day course of
Augmentin for bronchitis with resolution of respiratory symptoms. In the last 2 weeks she has developed
diffuse arthritis of hands, knees, elbows, and ankles.
Labs include WBC of 7.8 (82% seg, 15% lymph, 3% eos), platelets of 159, alkaline phosphatase of 454, ALT/AST
137/118 and bilirubin 1.9.
CRP is 183.6, rheumatoid factor <10, ANA negative. Ferritin is 8622
CT scan of the abdomen shows hepatosplenomegaly and peri-portal lymphadenopathy.
What is the most likely diagnosis for this patient?
A. Adult-onset Still’s disease
B. DRESS (drug associated rash with eosinophilia and systemic symptoms)
C. SLE (systemic lupus erythematosus)
D. HLH (hemophagocytic lymphohistiocytosis)
E. Acute CMV infection
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