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Muller R, Briantais A, Faucher B, Borentain P, Nafati C, Blasco V, Gregoire E, Bernit E, Seguier J, Meunier B, Harlé JR, Ebbo M, Schleinitz N. Acute severe hepatitis in adult-onset Still's disease: case report and comprehensive review of a life-threatening manifestation. Clin Rheumatol 2020; 40:2467-2476. [PMID: 32955629 DOI: 10.1007/s10067-020-05383-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
Acute severe hepatitis is a rare complication of adult-onset Still's disease (AOSD). This condition is poorly characterized. We performed a review of the medical literature to describe clinical, biological, pathological, and treatment characteristics from AOSD patients with acute severe hepatitis. Their characteristics were compared with AOSD patients without severe hepatitis. Twenty-one cases were collected including a new case reported here. Patients with severe hepatitis were mostly young adults with a median age of 28 years (range: 20 to 55 years). Overall, patients with severe hepatitis had less arthritis, macular rash, sore throat, lymphadenopathy, or splenomegaly than patients without severe hepatitis. Cytopenia was more frequent in case of severe hepatitis. Most patients were treated with steroids, and the use of biotherapies has increased over the last decade. Despite treatment, 49% of patients required liver transplantation and 24% died. Key Points • Acute severe hepatitis in adult-onset Still's disease (AOSD) is associated with liver transplantation and/or death in, respectively, 43% and 24% of cases. • Severe hepatitis is the inaugural manifestation of AOSD in half of cases. Diagnosis is difficult when extra-hepatic clinical manifestations are lacking. • The mechanism of hepatic necrosis in AOSD with severe hepatitis is unknown. Liver biopsy is not specific and should not delay treatment initiation.
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Affiliation(s)
- Romain Muller
- Service de médecine interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Antoine Briantais
- Service de médecine interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Benoit Faucher
- Service de médecine interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Patrick Borentain
- Service d'hépato-gastro-entérologie, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Cyril Nafati
- Réanimation polyvalente et des pathologies du foie, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Valery Blasco
- Réanimation polyvalente et des pathologies du foie, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Emilie Gregoire
- Service de chirurgie digestive, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Emmanuelle Bernit
- Service de médecine interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Julie Seguier
- Service de médecine interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Benoit Meunier
- Service de médecine interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Jean-Robert Harlé
- Service de médecine interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Mikael Ebbo
- Service de médecine interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | - Nicolas Schleinitz
- Service de médecine interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France.
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Iwamoto M. [Macrophage activation syndrome associated with adult-onset Still's disease]. ACTA ACUST UNITED AC 2008; 30:428-31. [PMID: 18174671 DOI: 10.2177/jsci.30.428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Macrophage activation syndrome (MAS) is a rare and potentially lethal disease, resulting from uncontrolled activation and proliferation of T lymphocytes and macrophages. Adult-onset Still's disease (AOSD) is an inflammatory disease. AOSD resemble reactive MAS in its symptoms and laboratory data. Moreover, AOSD per se induces MAS. It is, therefore, quite difficult to differentiate these syndrome and disease. The immunodeficiency state induced by treatment in AOSD could reactivate latent viruses such as Epstein-Barr virus, which could potentially lead to MAS. The therapeutic agents for AOSD, such as sulfasalazine, also could provoke reactive MAS. Because multiple factors are involved in inducing MAS to a different degree, the main cause should be searched for and targeted for the therapy.
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Affiliation(s)
- Masahiro Iwamoto
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Jichi Medical University
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Saito Y, Toriumi S, Otake R, Suzuki M. [Adult-onset Still's disease following severe sore throat and fever. Case report]. NIHON JIBIINKOKA GAKKAI KAIHO 2008; 111:21-24. [PMID: 18260301 DOI: 10.3950/jibiinkoka.111.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Adult-onset Still's disease (AOSD) is characterized by fever, rash, and joint pain and may lead to chronic arthritis. The cause of AOSD is unknown, and it is rare. In children, Still's Disease is called systemic juvenile rheumatoid arthritis. We encountered a patient with adult-onset Still's disease following a severe sore throat and fever. The patient was a 17-year-old woman who consulted our hospital because of a sore throat and fever. She was admitted and treated with antibiotics, but the fever persisted. Laboratory parameters of inflammatory activity increased at an accelerated rate, and after ruling out sepsis, EBV-associated disease, and malignant lymphoma, a diagnosis of AOSD was made. Steroid therapy was very effective. When acute pharyngitis is observed in association with significant changes in laboratory parameters despite mild local symptoms, or when pharyngitis is observed in association with joint pain, continuous fever, and a rash, it is important to consider AOSI).
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Affiliation(s)
- Yuki Saito
- Department of Otolaryngology, Takeda General Hospital, Fukushima
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Arlet JB, Le THD, Marinho A, Amoura Z, Wechsler B, Papo T, Piette JC. Reactive haemophagocytic syndrome in adult-onset Still's disease: a report of six patients and a review of the literature. Ann Rheum Dis 2006; 65:1596-601. [PMID: 16540551 PMCID: PMC1798476 DOI: 10.1136/ard.2005.046904] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the prevalence and characteristics of patients with reactive haemophagocytic syndrome (RHS) complicating adult-onset Still's disease (AOSD). METHODS Of 50 patients with AOSD fulfilling Yamaguchi and Fautrel criteria followed in our department, clinical and laboratory data, course and treatment of six patients with histologically proven RHS and without any obvious cause other than AOSD were retrospectively recorded. RESULTS RHS led to AOSD in two cases, whereas it appeared after a mean duration of 3.5 years from onset of AOSD in the other cases. The main symptoms were fever (n = 6), polyarthralgias or myalgias (n = 4), lymphadenopathy or splenomegaly (n = 3), pharyngitis (n = 3), rash (n = 3), pleuritis (n = 3), hepatomegaly (n = 1), normal or low leucocyte count (n = 4), anaemia (n = 6), lymphocytopenia (n = 6), thrombocytopenia (n = 4), hyperbasophilic lymphocytes (n = 2), abnormal liver function tests (n = 6) and increased serum triglyceride level (n = 6). Serum ferritin concentration was constantly increased (>10,000 microg/l in five cases, with <5-35% in glycosylated form). Two patients presented with coagulopathy. Treatment comprised corticosteroids (n = 4) and intravenous immunoglobulins (n = 3), whereas prednisone was unchanged in one case. One death due to pneumonia occurred 15 days after RHS. With a follow-up ranging from 2 to 7.5 years, the other patients were in remission with prednisone plus etanercept (n = 1), prednisone plus methotrexate (n = 1), low-dose prednisone (n = 2) or without treatment (n = 1). CONCLUSION RHS is not uncommon in AOSD. It should be evoked in a patient with AOSD in the absence of hyperleucocytosis, thrombocytopenia, lymphopenia and coagulopathy, or in the presence of high serum ferritin and triglyceride levels.
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Affiliation(s)
- J-B Arlet
- Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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