# An Unusual Case of Fever in Paralytic Ileus

## TL;DR

A 19-year-old man with high fever and paralytic ileus was treated successfully with steroids and cyclophosphamide, suggesting a rare autoimmune condition.

## Contribution

This case highlights an unusual presentation of Still's disease and its management with immunosuppressive therapy.

## Key findings

- The patient showed rapid improvement with intravenous glucocorticoids and cyclophosphamide.
- Tofacitinib was initiated during follow-up based on clinical response.
- The case suggests an autoimmune origin for the fever and ileus.

## Abstract

Still's disease is frequently a condition of exclusion for patients with an unidentified cause of fever. Accompanying symptoms typically include fever, arthralgia, and a transient skin rash. The underlying pathophysiology indicates an autoimmune origin. Diagnosis is primarily clinical, often utilizing the Yamaguchi criteria. The case in question involves a 19-year-old male presenting with high-grade fever and paralytic ileus. The patient received intravenous glucocorticoids and cyclophosphamide, resulting in a rapid clinical improvement. During the follow-up, tofacitinib was initiated based on the clinical response observed.