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Adult onset Still's disease (AOSD) is a chronic multisystemic inflammatory disorder of unknown origin characterized by a high spiking fever, polyarthralgia and skin rash. A 30 year-old woman was admitted to our hospital because of fever, miyalgia, poliarthralgia, urticeria and cervical lymphadenopathy. Cervical lymph node biopsy was performed and histological study showed immunoblastic and monocytic–hystiocitic cell proliferation that resemble malignant lymphoma in interfollicular area. The patient was diagnosed as possible AOSD and was initiated moderate-dose (32 mg/day) methylprednisolone, methotrexate and hydroxychloroquine treatment. The symptoms were alleviated and laboratory values normalized after the treatment.

Hemophagocytic syndrome (HS) is a rare clinical condition characterized by fever and cytopenia due to phagocytosis of erythrocytes, leukocytes, platelets and their precursors in the bone marrow and other reticuloendothelial systems. The presence of HS can be associated with malignancies, infections, drugs and a variety of other medical disorders. We report a patient with seronegative spondyloarthropathy treated with sulfasalazine and was complicated by the occurrence of fever, facial erythema and pancytopenia. The patient was diagnosed with HS and successfully treated with corticosteroids.