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Uchihara D, Suzuki T, Koya Y, Tai M, Ichii O, Matsuhashi N, Ejiri Y, Kato T, Honma Y, Shibata M, Harada M. Autoimmune hepatitis complicated by adult-onset Still's disease during treatment with tocilizumab: A case report from acute onset to recurrence. Clin Case Rep 2023; 11:e7530. [PMID: 37397575 PMCID: PMC10310897 DOI: 10.1002/ccr3.7530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/27/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
The characteristics of liver dysfunction due to adult-onset Still's disease are not specific. Differentiating from autoimmune hepatitis is important in deciding whether to continue corticosteroid therapy, and also in terms of management of cirrhosis and surveillance of hepatocellular carcinoma. Liver biopsy is thought to be the most important determinant for differential diagnosis.
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Affiliation(s)
- Daiki Uchihara
- Department of GastroenterologyFukushima Rosai HospitalIwakiJapan
- Third Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Tomohiro Suzuki
- Department of GastroenterologyFukushima Rosai HospitalIwakiJapan
| | - Yudai Koya
- Third Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Mayumi Tai
- Department of GastroenterologyFukushima Rosai HospitalIwakiJapan
- Third Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Osamu Ichii
- Department of GastroenterologyFukushima Rosai HospitalIwakiJapan
| | - Nobuo Matsuhashi
- Department of GastroenterologyFukushima Rosai HospitalIwakiJapan
| | - Yutaka Ejiri
- Department of GastroenterologyFukushima Rosai HospitalIwakiJapan
| | - Tomoya Kato
- Department of PathologyFukushima Rosai HospitalIwakiJapan
| | - Yuichi Honma
- Third Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Michihiko Shibata
- Third Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Masaru Harada
- Third Department of Internal Medicine, School of MedicineUniversity of Occupational and Environmental HealthKitakyushuJapan
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Ogasawara Y, Kogiso T, Kotera Y, Omori A, Konda N, Sugano E, Sagawa T, Taniai M, Harigai M, Egawa H, Yamamoto M, Tokushige K. The utility of liver transplantation to treat acute liver failure caused by adult-onset Still's disease: case reports. Clin J Gastroenterol 2021; 14:866-875. [PMID: 33797038 DOI: 10.1007/s12328-021-01398-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Adult-onset Still's disease (AOSD) is an inflammatory condition commonly complicated by mild liver dysfunction. However, severe liver failure is rarely reported. We report three cases of severe acute hepatic failure (ALF) associated with AOSD. We encountered three cases of acute liver failure (ALF) with encephalopathy. RESULTS Case 1 was a 75-year-old female, who was started on a steroid (prednisolone, PSL) to treat AOSD; this was gradually tapered. Two months later, severe ALF developed. She died despite an increase in the PSL dose and artificial liver support. Case 2 was a 26-year-old-female taking PSL 30 mg/day to treat subacute thyroiditis. PSL was tapered, and she received methyl PSL pulse therapy and artificial liver support, but this did not cure the ALF. Liver transplantation (LT) was performed 25 days later. Three years later, the same symptoms were observed and we diagnosed AOSD. Case 3 was a 56-year-old-female who met the AOSD criteria. PSL 50 mg/day was started and then tapered. Methyl PSL pulse therapy was prescribed to treat hemophagocytic syndrome, but she required LT on hospital day 13. CONCLUSION In AOSD cases, ALF is rarely complicated; urgent LT should be considered only for patients with AOSD-related severe ALF.
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Affiliation(s)
- Yuri Ogasawara
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tomomi Kogiso
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Yoshihito Kotera
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Akiko Omori
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Naoko Konda
- Department of Rheumatology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Eri Sugano
- Department of Rheumatology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takaomi Sagawa
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Makiko Taniai
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Katsutoshi Tokushige
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Khamashta MA, Ramos-Casals M. Complex Situations in Patients with Adult-Onset Still’s Disease. Autoimmune Dis 2011. [PMCID: PMC7122824 DOI: 10.1007/978-0-85729-358-9_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology, characterized by quotidian or double quotidian fever, a peri-febrile cutaneous eruption, polyarthritis, and multiorgan involvement. AOSD is a challenging disease with protean disease manifestations and rare, albeit potentially life-threatening, complications. In such cases, prompt diagnosis and treatment may prove life-saving. The purpose of this chapter is to review the diagnosis and management of challenging clinical situations in AOSD patients that are associated with significant morbidity and mortality and to provide the readers with information that could aid their decision-making process.
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Affiliation(s)
- Munther A. Khamashta
- Rayne Institute, Lupus Research Unit, St. Thomas' Hospital, London, SE1 7EH United Kingdom
| | - Manuel Ramos-Casals
- Barcelona, Surgey, Hospital Clinic, Calle Villarroel, 170, Barcelona, 08036 Spain
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