[Adult Still's disease: an unrecognized cause of acute febrile hepatic cytolysis. Study of twelve patients].
OBJECTIVE
Certain liver test abnormalities have been described in adult Still's disease. The objective of the present study was to analyze their type and frequency.


METHODS
In a 10 year retrospective study, patients were included if they fulfilled Kahn's and/or Yamaguchi's diagnostic criteria (median follow-up: 6.5 years).


RESULTS
Twelve patients were selected. The median age was 25 years old and the sex ratio H/F was 2.7. Fever was present in 100% of patients and hepatomegaly in 41%. Liver test abnormalities were identified in 92% of patients: moderate cytolysis (level of transaminases between 2 and 5 N) (83%), severe cytolysis (level of transaminases > 5 N) (17%), cholestasis (elevated levels of GGT and/or alkaline phosphatase) (75%), and an increase in the LDH level (41%). All these liver abnormalities resolved spontaneously or during treatment (83%), within a median of 18 days.


CONCLUSIONS
Our study confirms the high frequency of liver test abnormalities (> 2/3 of the patients) in adult Still's disease. These abnormalities are generally moderate and asymptomatic (3/4 of the cases), but severe cytolysis may exist. This emphasizes the need to consider a diagnosis of adult Still's disease in the presence of fever and elevated transaminase activity.
Andrès
E
E
Service de Médecine Interne et Nutrition, Hôpitaux Universitaires, Strasbourg, France. emmanuel.andres@chru-strasbourg.fr
Ruellan
A
A
Pflumio
F
F
Perrin
A E
AE
Goichot
B
B
Grunenberger
F
F
Imler
M
M
Schlienger
J L
JL
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D005334:Fever; D006529:Hepatomegaly; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008099:Liver / Q000201:enzymology; D008107:Liver Diseases / Q000201:enzymology* / Q000209:etiology*; D012189:Retrospective Studies; D016706:Still's Disease, Adult-Onset / Q000150:complications*; D005723:gamma-Glutamyltransferase / Q000097:blood
D007770:L-Lactate Dehydrogenase; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase