The patient was diagnosed with Adult-Onset Still’s Disease, a rare autoimmune condition.
Dubai: Most fevers come and go within a few days, but what happens when the temperature keeps rising, tests keep coming back negative, and no one can explain why?
That was the frightening reality for a 34-year-old Abu Dhabi resident whose persistent high-grade fever lasted for more than two weeks, turning what initially appeared to be a common illness into a medical mystery.
The man had previously been in good health, but despite multiple hospital visits and investigations — including blood cultures and standard infection screening tests — doctors were unable to identify the cause of his worsening condition.
As the fever persisted, additional symptoms began to emerge. Severe joint pain made movement difficult, while extreme fatigue left him struggling with daily activities. Tests also revealed significant inflammation and liver involvement, raising concerns among doctors that a more serious underlying condition could be at play.
Although he appeared clinically stable, the persistence and severity of his symptoms prompted specialists at Burjeel Hospital in Abu Dhabi to look beyond the usual causes of prolonged fever. What they eventually discovered was a rare autoimmune disorder that affects only one to four people per million worldwide.
Although he appeared clinically stable, the persistence and severity of his symptoms prompted specialists at Burjeel Hospital in Abu Dhabi to look beyond the usual causes of prolonged fever. What they eventually discovered was a rare autoimmune disorder affecting just one to four people per million worldwide.
One challenge was that the patient did not present with a rash, a symptom frequently associated with the disease in medical textbooks. However, Dr Khalid noted that rashes can be absent or difficult to detect, particularly in people with darker skin tones.
Instead, doctors relied on a combination of other findings. The patient had prolonged fever, severe inflammation, liver involvement, and markedly elevated ferritin levels, while all infectious and autoimmune tests returned negative.
“The extraordinarily high ferritin, a marker of inflammation, acted as a critical diagnostic signal. When these features came together, along with high-grade fever spiking daily at regular intervals, AOSD became the most likely explanation, although it is extremely rare,” he said.
Fever can become dangerous
While fever is usually the body’s natural response to infection, doctors emphasise that persistent fever accompanied by severe inflammation can sometimes indicate a more serious underlying condition.
In Adult-Onset Still’s Disease (AOSD), the immune system becomes overactive and attacks the body’s own tissues, triggering widespread inflammation. If not recognised and treated in time, the condition can progress to chronic inflammatory arthritis, organ damage, liver failure, or a potentially fatal immune reaction known as macrophage activation syndrome.
For the Abu Dhabi resident, the physical and emotional toll had already become overwhelming.
“During those days, I shivered from fever and struggled to get up from bed, lift my hands, and move my body. There was no appetite because of throat pain. Despite taking medicine, my fever recurred, draining me emotionally. I prayed to God to give my routine life back,” the patient recalled.
A dramatic turnaround
Once doctors suspected AOSD, they immediately started high-dose corticosteroid therapy, the standard treatment used to suppress the abnormal immune response driving the disease.
“Within 24 hours, the fever subsided. Within 48 hours, the patient felt significantly better, with improvements in joint pain and energy levels. Laboratory markers also improved in parallel,” Dr Khalid said.
Following the initial high-dose treatment, the medication was gradually tapered over several weeks to ensure a safe recovery while keeping inflammation under control. For the patient, the turnaround felt almost unbelievable after weeks of uncertainty.
“I am so happy that I can move my body without support for the first time in a while. Everyone in the hospital gave me hope whenever I doubted, got frustrated, and questioned myself,” the patient said.
Lesson beyond one patient
Although the patient has recovered remarkably well, his journey is not entirely over. Doctors note that Adult-Onset Still’s Disease (AOSD) can recur in some patients, making ongoing follow-up essential.
His case also serves as a reminder that when a fever persists for weeks without an obvious explanation, it may be a warning sign of a more complex underlying condition.
Meanwhile, he will continue regular monitoring with internal medicine and rheumatology specialists to watch for any signs of relapse and ensure long-term stability.
