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Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease

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, corticoster...

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Autores principales: Lee, Chin-Chi, Peng, Yi-Jen, Lu, Chun-Chi, Chen, Hsiang-Cheng, Yeh, Fu-Chiang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876503/
https://www.ncbi.nlm.nih.gov/pubmed/35208515
http://dx.doi.org/10.3390/medicina58020191
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author Lee, Chin-Chi
Peng, Yi-Jen
Lu, Chun-Chi
Chen, Hsiang-Cheng
Yeh, Fu-Chiang
author_facet Lee, Chin-Chi
Peng, Yi-Jen
Lu, Chun-Chi
Chen, Hsiang-Cheng
Yeh, Fu-Chiang
author_sort Lee, Chin-Chi
collection PubMed
description 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.
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spelling pubmed-88765032022-02-26 Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease Lee, Chin-Chi Peng, Yi-Jen Lu, Chun-Chi Chen, Hsiang-Cheng Yeh, Fu-Chiang Medicina (Kaunas) Case Report 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. MDPI 2022-01-27 /pmc/articles/PMC8876503/ /pubmed/35208515 http://dx.doi.org/10.3390/medicina58020191 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/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/).
spellingShingle Case Report
Lee, Chin-Chi
Peng, Yi-Jen
Lu, Chun-Chi
Chen, Hsiang-Cheng
Yeh, Fu-Chiang
Corticosteroid-Induced Liver Injury in Adult-Onset Still’s Disease
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 Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876503/
https://www.ncbi.nlm.nih.gov/pubmed/35208515
http://dx.doi.org/10.3390/medicina58020191
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