Based on the patient's clinical and laboratory studies, a diagnosis of Still's disease was made. Three days after admission to the hospital, her liver enzymes became elevated. Two days later, the patient complained of shortness of breath with saturation of 85% at room air. Her chest Xrays were compatible with acute respiratory distress syndrome (ARDS). Her serum ferritin level rose to 10,648 ng/ ml; her CRP rose to 27.7; and her ESR was at 102 mm/1 hour. A complete blood count showed anemia with hemoglobin values of 7.7 Gr%, a platelet count of 75,000 Gr% and white blood cell count of 18,000 (neutrophils 93%).