Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease
<i>Background and Objectives</i>: 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. H...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-01-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/58/2/191 |
| _version_ | 1797478262591455232 |
|---|---|
| author | Chin-Chi Lee Yi-Jen Peng Chun-Chi Lu Hsiang-Cheng Chen Fu-Chiang Yeh |
| author_facet | Chin-Chi Lee Yi-Jen Peng Chun-Chi Lu Hsiang-Cheng Chen Fu-Chiang Yeh |
| author_sort | Chin-Chi Lee |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: 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. <i>Materials and Methods</i>: 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. <i>Results</i>: 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. <i>Conclusions</i>: 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. |
| first_indexed | 2024-03-09T21:29:27Z |
| format | Article |
| id | doaj.art-54b459d3494842398cb18d778e3ead13 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T21:29:27Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-54b459d3494842398cb18d778e3ead132023-11-23T20:59:25ZengMDPI AGMedicina1010-660X1648-91442022-01-0158219110.3390/medicina58020191Corticosteroid-Induced Liver Injury in Adult-Onset Still’s DiseaseChin-Chi Lee0Yi-Jen Peng1Chun-Chi Lu2Hsiang-Cheng Chen3Fu-Chiang Yeh4Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, TaiwanDepartment of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, TaiwanDepartment of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, TaiwanDepartment of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, TaiwanDepartment of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan<i>Background and Objectives</i>: 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. <i>Materials and Methods</i>: 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. <i>Results</i>: 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. <i>Conclusions</i>: 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.https://www.mdpi.com/1648-9144/58/2/191adult-onset Still’s diseasecorticosteroidsdrug-induced liver injury |
| spellingShingle | Chin-Chi Lee Yi-Jen Peng Chun-Chi Lu Hsiang-Cheng Chen Fu-Chiang Yeh Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease Medicina adult-onset Still’s disease corticosteroids drug-induced liver injury |
| title | Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease |
| title_full | Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease |
| title_fullStr | Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease |
| title_full_unstemmed | Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease |
| title_short | Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease |
| title_sort | corticosteroid induced liver injury in adult onset still s disease |
| topic | adult-onset Still’s disease corticosteroids drug-induced liver injury |
| url | https://www.mdpi.com/1648-9144/58/2/191 |
| work_keys_str_mv | AT chinchilee corticosteroidinducedliverinjuryinadultonsetstillsdisease AT yijenpeng corticosteroidinducedliverinjuryinadultonsetstillsdisease AT chunchilu corticosteroidinducedliverinjuryinadultonsetstillsdisease AT hsiangchengchen corticosteroidinducedliverinjuryinadultonsetstillsdisease AT fuchiangyeh corticosteroidinducedliverinjuryinadultonsetstillsdisease |