Successful methotrexate therapy for adult Still's disease with marked thrombocytopenia.
A 34-year-old Japanese woman developed spiking fever, splenomegaly, arthritis, neutrophilia, hyperferritinaemia (22517 ng/ml), elevated C-reactive protein (9.1 mg/ml) and severe thrombocytopenia (1.7 x 10(4)/microl). The patient had depressed antithrombin III activity and abnormally high concentrations of both fibrin degradation products and thrombin-antithrombin complexes. This condition was resistant to high-dose prednisolone therapy (120 mg/day) and non-steroidal anti-inflammatory drugs. We initiated oral methotrexate therapy (7.5 mg/week, orally) with a favourable outcome. The patient's spiking fever subsided on the first day of methotrexate administration. Elevated levels of ferritin and C-reactive protein in the sera rapidly normalised. Methotrexate rapidly improved the disease state which suggested that methotrexate act via modulation of cytokine production or secretion.
Yamaguchi
M
M
First Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Matsukawa
Y
Y
Takahashi
N
N
Takei
M
M
Tomita
Y
Y
Nishinarita
S
S
Horie
T
T
D000284:Administration, Oral; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D016706:Still's Disease, Adult-Onset / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013921:Thrombocytopenia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate