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© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background and Objectives: Adult-onset Still’s disease (AOSD) is a rheumatic disease characterized by systemic inflammatory symptoms, including intermittent spiking fever, polyarthritis and a distinctive salmon-colored rash. Corticosteroids are the first-line treatment for AOSD. However, corticosteroids are potentially hepatotoxic in certain cases and may complicate the course of the disease. Materials and Methods: A 29-year-old female suffering from fever of unknown origin for two weeks was diagnosed with AOSD according to Yamaguchi’s criteria. She received corticosteroids as the first-line treatment for AOSD and developed acute severe hepatitis. A diagnostic protocol has been performed. Results: Corticosteroid-induced liver injury was confirmed by clinical observation and rechallenge of the drug in this case. The result of liver biopsy also supported the diagnosis. Mycophenolic acid, a disease-modifying antirheumatic drug (DMARD) was chosen as an alternative treatment. AOSD remission was achieved under this treatment after three months. Conclusions: Severe acute hepatitis induced by corticosteroids, although very rare, may be observed in patients with AOSD. Drug-induced liver injury needs to be kept in mind when unexpected acute hepatitis is found. Mycophenolic acid could be a proper substitute medication in these cases.

Details

Title
Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease
Author
Chin-Chi, Lee 1   VIAFID ORCID Logo  ; Yi-Jen, Peng 2   VIAFID ORCID Logo  ; Chun-Chi, Lu 3   VIAFID ORCID Logo  ; Hsiang-Cheng, Chen 3 ; Fu-Chiang Yeh 4 

 Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] (C.-C.L.); [email protected] (C.-C.L.); [email protected] (H.-C.C.) 
 Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] 
 Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] (C.-C.L.); [email protected] (C.-C.L.); [email protected] (H.-C.C.); Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan 
 Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] (C.-C.L.); [email protected] (C.-C.L.); [email protected] (H.-C.C.); Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Penghu Branch, Tri-Service General Hospital, Penghu 880, Taiwan 
First page
191
Publication year
2022
Publication date
2022
Publisher
MDPI AG
ISSN
1010660X
e-ISSN
16489144
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2632959796
Copyright
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.