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.
First Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
M
M
Yamaguchi
Y
Y
Matsukawa
N
N
Takahashi
M
M
Takei
Y
Y
Tomita
S
S
Nishinarita
T
T
Horie
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