Burjeel's 6,900 ng/mL AOSD case exposes rare-disease pathway gaps in Abu Dhabi

Burjeel Hospital Abu Dhabi diagnosed a 34-year-old resident with Adult-Onset Still's Disease (AOSD) after more than 14 days of unexplained fever.

For medical directors and COOs, the number to remember is 6,900 ng/mL: the patient's ferritin level, according to Aletihad, was more than 15 times the usual upper limit and helped move the case out of a broad fever workup.

The clinical signal

The patient had high-grade fever for more than 14 days, disabling joint pain, fatigue, severe inflammation and signs of liver involvement, according to Aletihad. Routine infection screens and blood cultures did not identify the cause. Burjeel's internal medicine team ruled out infections, other autoimmune diseases and malignancies before diagnosing AOSD, a rare inflammatory condition estimated to affect about one to four people per million worldwide.

"It mimics many life-threatening diseases such as severe infections, autoimmune disorders, liver disease, and even cancer." Dr Niyas Khalid, Specialist, Internal Medicine, Burjeel Hospital Abu Dhabi.

Dr Niyas Khalid said healthy adult ferritin levels are usually 30 to 400 ng/mL, depending on age and sex. This patient's ferritin reached 6,900 ng/mL. Burjeel started high-dose corticosteroid therapy once AOSD was suspected. Fever fell within 24 hours, while joint pain and energy improved within 48 hours, according to Aletihad.

Why operators should care

AOSD has no single confirmatory antibody test, so delayed recognition can create repeat visits, wider test panels and higher escalation risk. In Abu Dhabi, those pathways sit under the Department of Health - Abu Dhabi (DOH). Dubai facilities report to the Dubai Health Authority (DHA), and Northern Emirates providers report to the Ministry of Health and Prevention (MOHAP).

For hospital operators, the case is a test of clinical governance across internal medicine, emergency medicine, rheumatology, laboratory medicine and revenue-cycle teams. A patient with recurrent fever can move through two or more encounters before the pattern is recognised, which makes escalation rules more important than one clinician's memory.

• Medical directors can check whether fever-of-unknown-origin protocols include ferritin thresholds, liver markers and rheumatology escalation.
• COOs can map handoffs between emergency, outpatient internal medicine and specialty referral for cases lasting more than seven days.
• CFOs can track repeat low-yield investigations tied to unclear fever pathways and bed-utilisation costs.
• CIOs can assess whether EHR alerts flag fever, high ferritin and negative infection screens in the same episode.

The market context

The regulatory context gives the case wider relevance. DOH describes itself as the regulator of Abu Dhabi's healthcare sector and sets the emirate's health strategy. In 2024, DOH and AstraZeneca signed an agreement to establish a rare diseases centre of excellence in Abu Dhabi. The centre was planned for rare diseases including neurology, haematology and metabolic conditions, according to a DOH announcement.

Rare disease capability also fits Abu Dhabi's healthcare and life-sciences plan, launched in 2023. The plan targets $2 billion in added economic activity, more than 600 active clinical trials, 290 biotech startups and 22,000 life-sciences jobs, according to the US International Trade Administration.

Burjeel said the patient recovered well but will need regular follow-up with internal medicine and rheumatology specialists because AOSD can recur. The practical takeaway for Abu Dhabi providers is specific: write ferritin triggers, escalation rules and relapse monitoring into everyday fever pathways before the next one-in-a-million patient arrives.