23 June 2023
: Case report 
An Initially Missed Diagnosis of Venous Thromboembolic Phenomenon in Adult-Onset Still’s Disease: A Case Report and Literature Review
Unusual clinical course, Mistake in diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology
Mahlatse Mankgele
1ABCDEFG*, Delisa Hlawe 1ABCDEFG, Zayithwa Fabiano1ABCDEFG, Ahmed Solomon2ABCDEFG, Riju Thomas3DF, Mbali Matyeshana4BCDF, Olwethu Mbakaza5DF, Mpoti Seboka2ABCDEFG
DOI: 10.12659/AJCR.939520
Am J Case Rep 2023; 24:e939520
Table 2. Work-up for 3 admissions January–March 2022.
| Parameter | Admission 1 | Admission 2 | Admission 3 | Reference range |
|---|---|---|---|---|
| SARS-CoV-2 PCR | Negative | Negative | Negative | |
| White cell count | 14.32×10/L | 18.9×10/L | 7.96×10/L | 3.9–12.6 |
| Hemoglobin | 11.9 g/dL | 12.8 g/dL | 11.5 g/dL | 11.6–16.4 |
| Mean cell volume | 92.6 fl | 88.9 fl | 87.6 fl | 78.9–98.5 |
| Platelets | 317×10/L | 304×10/L | 199×10/L | 186–454 |
| Erythrocyte sedimentation rate | 111 mm/hr | 66 mm/hr | <10 | |
| C-reactive protein | 105 mg/L | 119 mg/L | <10 | |
| Procalcitonin | 1.42 ug/L | 0.43 ug/L | <0.1 | |
| ALP | 299 u/l | 159 U/L | 99 U/L | 42–89 |
| AST | AST 48U/L | 23 U/L | 13–35 | |
| ALT | 35 U/L | 52 U/L | 26 U/L | 7–35 |
| Ferritin | 2894 mcg/L | <15 | ||
| Blood cultures | No growth | |||
| Urine cultures | No growth | |||
| SARS-CoV-2 PCR | Negative | |||
| D-Dimer | 11.10 mg/L | 1.26 mg/L | 1.23 mg/L | <0.25 |
| Troponin | 5 ng/mL | 4 ng/ml | <14 | |
| INR | 1.00 | |||
| PTT patient/control | 14.0/14.0 seconds | |||
| Blood culture | No growth | No growth | ||
| Tuberculosis culture | No growth | No growth | ||
| Sputum GeneXpert | Negative | |||
| Sputum Auramine | Negative | |||
| Vitamin B12 | 354 pmol/L | 145–569 | ||
| HIV ELISA | Negative | |||
| Hepatitis B surface antigen | Negative | |||
| Hep C antibody | Negative | |||
| Protein C | 130 IU/dL | 70–130 | ||
| Protein S | 105 IU/dL | 55–123 | ||
| Antithrombin | 106 IU/dL | 80–120 | ||
| Factor V Leiden | Normal | |||
| Prothrombin 20210A | Normal | |||
| Lupus anticoagulant | Negative | |||
| Anti-beta 2 glycoprotein | Negative | |||
| Anticardiolipin antibody | Negative | |||
| C3 | 1.91 g/L | 0.9–1.8 | ||
| C4 | 0.78 g/L | 0.1–0.4 | ||
| Rheumatoid factor | 8 | <10 | ||
| Anti-CCP | Negative | |||
| ANA | Positive/Titer160/speckled | |||
| Anti-dsDNA | Negative | |||
| Uric acid | 0.13 mmol/L | 0.16–0.36 | ||
| ANCA | Negative | |||
| Urine protein: creatinine ratio | 0.014 | <0.015 | ||
| Smear | Left shift with toxic granulation | No abnormalities |