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Kaya MN, Kılıç Ö, Güneş EÇ, Tecer D, Yılmaz S. Indices and ferritin level that predict organ involvement in adult-onset Still's disease. Biomark Med 2024:1-8. [PMID: 39317410 DOI: 10.1080/17520363.2024.2403330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 09/09/2024] [Indexed: 09/26/2024] Open
Abstract
Aim: The aim of the study is to evaluate whether C-reactive protein to albumin ratio (CAR), lactate dehydrogenase to albumin ratio (LAR), ferritin to erythrocyte sedimentation rate ratio (FER), systemic immune-inflammation index (SII), prognostic nutritional index (PNI) indices and ferritin level can predict organ involvement in adult-onset Still's disease (AOSD) patients.Methods: This study was planned as a cross-sectional study. Univariate and multivariate logistic regression analyses were performed to evaluate the usefulness of ferritin level and inflammatory indices in defining organ involvement.Results: Sixty-one patients diagnosed with AOSD were included in this study. Multivariate logistic regression analyzes showed that LAR (OR 1.028, 95% CI: 1.011-1.044) (p = 0.001) index predicted lymphadenopathy involvement, CAR (OR 1.249, 95% CI: 1.087-1.435) (p = 0.002) index predicted hepatomegaly involvement, ferritin level (OR 1.004, 95% CI: 1.001-1.008) (p = 0.007) predicted splenomegaly involvement, FER (OR 1.085, 95% CI: 1.012-1.164) (p = 0.021) and PNI (OR 0.271, 95% CI: 1.132-0.553) (p < 0.001) index predicted the occurrence of serositis.Conclusion: This study showed that ferritin level, CAR, FER, PNI and LAR markers may predict organ involvement at diagnosis in AOSD patients.
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Affiliation(s)
- Mehmet Nur Kaya
- University of Health Sciences Turkey, Gülhane Training & Research Hospital, Rheumatology Department, Ankara, 38100, Turkey
| | - Özlem Kılıç
- University of Health Sciences Turkey, Gülhane Training & Research Hospital, Rheumatology Department, Ankara, 38100, Turkey
| | - Ezgi Çimen Güneş
- University of Health Sciences Turkey, Gülhane Training & Research Hospital, Rheumatology Department, Ankara, 38100, Turkey
| | - Duygu Tecer
- University of Health Sciences Turkey, Gülhane Training & Research Hospital, Rheumatology Department, Ankara, 38100, Turkey
| | - Sedat Yılmaz
- University of Health Sciences Turkey, Gülhane Training & Research Hospital, Rheumatology Department, Ankara, 38100, Turkey
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Sola D, Smirne C, Bruggi F, Bottino Sbaratta C, Tamen Njata AC, Valente G, Pavanelli MC, Vitetta R, Bellan M, De Paoli L, Pirisi M. Unveiling the Mystery of Adult-Onset Still's Disease: A Compelling Case Report. Life (Basel) 2024; 14:195. [PMID: 38398704 PMCID: PMC10890189 DOI: 10.3390/life14020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder. Diagnosis can take a long time, especially in the presence of confounding factors, and it is, to some extent, a process of exclusion. AOSD has life-threating complications ranging from asymptomatic to severe, such as macrophage activation syndrome (MAS), which is also referred to as hemophagocytic lymphohistocytosis (HLH). This condition is correlated with cytokine storm production and monocyte/macrophage overactivation and typically occurs with rash, pyrexia, pancytopenia, hepatosplenomegaly and systemic involvement. Exitus occurs in approximately 10% of cases. For the treatment of MAS-HLH, the Histiocyte Society currently suggests high-dose corticosteroids, with the possible addition of cyclosporine A, anti-interleukin (IL)-1, or IL-6 biological drugs; the inclusion of etoposide is recommended for the most severe conditions. In all cases, a multidisciplinary collaboration involving the resources and expertise of several specialists (e.g., rheumatologist, infectiologist, critical care medicine specialist) is advised. Herein, we provide a detailed description of the clinical case of a previously healthy young woman in which MAS developed as a dramatic onset manifestation of AOSD and whose diagnosis posed a real clinical challenge; the condition was finally resolved by applying the HLH-94 protocol (i.e., etoposide in combination with dexamethasone).
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Affiliation(s)
- Daniele Sola
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
- CAAD (Center for Autoimmune and Allergic Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Carlo Smirne
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Francesco Bruggi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Chiara Bottino Sbaratta
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Aubin Cardin Tamen Njata
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Guido Valente
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Pathology Unit, Sant'Andrea Hospital, 13100 Vercelli, Italy
| | | | - Rosetta Vitetta
- Rheumatology Unit, Sant'Andrea Hospital, 13100 Vercelli, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
- CAAD (Center for Autoimmune and Allergic Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
| | | | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
- CAAD (Center for Autoimmune and Allergic Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
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Herrera-Quintana JF, Rojas-Figueroa AC, Aragón-Mendoza RL, Gallo-Roa R, Castillo-Zamora MF. Pure red-cell aplasia secondary to pregnancy: Case report and review of the literature. ACTA ACUST UNITED AC 2020; 71:365-373. [PMID: 33515443 DOI: 10.18597/rcog.3543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/18/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report a case of pure red-cell aplasia secondary to pregnancy and to conduct a review of the literature regarding diagnosis and treatment, as well as maternal and perinatal prognosis. METHODS This is the case of a 24-year-old patient at 34 weeks of gestation, referred to a regional public referral hospital due to anemia. Bone marrow biopsy was performed, leading to the diagnosis of pregnancy-related pure red-cell aplasia. The patient received serial red blood cell transfusions. Delivery by Cesarean section at term resulted in a healthy newborn. Hemoglobin values remained stable during the postoperative period. A literature search was conducted in Medline via PubMed, LILACS, SciELO and ScienceDirect using the terms "pregnancy" and "pure red-cell aplasia". Case reports, case series and literature reviews in English and Spanish published between January 1999 and January 2020 that report pregnant women with pure red-cell aplasia were included. Information on diagnosis, treatment and maternal and perinatal prognosis was collected. Three of the authors selected the studies by title and abstract; A descriptive synthesis is provided. RESULTS Overall, 828 titles were identified; of these,818 were discarded after reviewing the inclusions criteria. Ten articles were included: six case reports, three case reports with literature review, and one case report in the poster modality, for a total number of 10 reported cases. Diagnosis was based on low hemoglobin levels and compromised erythroid cell line in bone marrow biopsy. Treatment consists of red blood cell transfusions, with good maternal and fetal prognosis. CONCLUSIONS Diagnosis of pure red-cell aplasia during pregnancy requires bone marrow biopsy. With transfusion support, maternal perinatal prognosis is good. Further studies are required to assess the safety and efficacy of steroid use in this pregnancy-related condition.
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Affiliation(s)
| | | | | | - Roberto Gallo-Roa
- Médico, ginecobstetra, Hospital Universitario de La Samaritana, Bogotá (Colombia)
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Pure Red Cell Aplasia with Adult Onset Still's Disease. Case Rep Med 2013; 2013:308342. [PMID: 24078815 PMCID: PMC3775397 DOI: 10.1155/2013/308342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/01/2013] [Indexed: 12/01/2022] Open
Abstract
Adult Onset Still's Disease (AOSD) is a rare inflammatory syndrome mostly seen in young adults. Known for its wide range of clinical manifestations, AOSD often presents with nonremitting systemic signs and symptoms. Many rare case associations have been described with AOSD, but only few with pure red cell aplasia (PRCA). We are presenting a fourth known case of a young female adult with AOSD and PRCA in the literature.
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Her MY, Kim TH, Chang HK, Lee WS, Yoo DH. Successful treatment of acquired amegakaryocytic thrombocytopenia with cyclosporine in adult onset Still's disease. Rheumatol Int 2006; 27:295-8. [PMID: 16957888 DOI: 10.1007/s00296-006-0202-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Accepted: 08/08/2006] [Indexed: 10/24/2022]
Abstract
Acquired amegakaryocytic thrombocytopenia (AAT) is a rare disorder, characterized by severe thrombocytopenia and selective, marked decrease or absence of megakaryocytes in the bone marrow. We describe a 29-year-old female with adult onset Still's disease preceding a diagnosis of AAT and autoimmune hemolytic anemia, which was successfully treated with cyclosporine. This is the first case of AAT in a patient with adult onset Still's disease.
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Affiliation(s)
- Min-Young Her
- Division of Rheumatology, The Hospital for Rheumatic Diseases, Hanyang University, Seoul, 133-792, South Korea
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