Aseptic Meningitis and Cranial Nerve Palsy Revealing Adult-Onset Still's Disease

admitted 2 weeks later with the same symptoms, and subendocardial myocardial infarction was diagnosed. An echocardiogram demonstrated a pericardial effusion without tamponade physiology, which was thought to be due to Dressler’s syndrome. During the next 5 months, the patient had progressive dyspnea on exertion. The effusion was unchanged on an outpatient echocardiogram. The patient was admitted with fevers and worsening exertional and rest dyspnea. Initial physical examination revealed tachypnea and temperature of 100.3°F. The patient had normal dentition, decreased breath sounds on the left, elevated jugular venous pressure, pulsus paradoxus, and distant heart sounds. Trace pedal edema was present bilaterally. The WBC count was 16,200/mL, erythrocyte sedimentation rate was 36 mm/h, and levels of alanine and aspartate aminotransferases were elevated. A chest radiograph showed massive cardiomegaly. Echocardiography demonstrated a large pericardial effusion with tamponade. A pericardial catheter drained 1,500 mL of nonhemorrhagic exudative fluid. Gram staining of the fluid showed moderate polymorphonuclear neutrophil leukocytes but no organisms; acid-fast staining was negative. After 4 days, gram-variable branching rods grew from the broth. These rods were identified as A. odontolyticus (API 20A/An-IDENT System,