[A case of adult-onset Still's disease complicated with acute respiratory distress syndrome].
A 24-year-old woman was admitted to our hospital because of a high fever that had persisted for two weeks. She complained of a sore throat and arthralgia, and had evanescent rash, lymphadenopathy, liver dysfunction, and hyperferritinemia. Tests for RF and ANA were negative. Adult-onset Still's disease was diagnosed. On the fifth day of hospitalization, acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC) developed. Treatment consisted of mechanical ventilation and administration of steroid pulse-therapy and gabexate mesilate. Analysis of fluid obtained by bronchoalveolar lavage showed increases in the total cell count, predominantly of neutrophils and lymphocytes. Bilateral pulmonary infiltration seen on chest radiographs was alleviated, and the arterial blood gas data gradually improved. After cyclosporine was given, all the above symptoms associated with adult-onset Still's disease disappeared. Plasma levels of inflammatory cytokines decreased with the improvement of the patient's clinical condition.
Mito
Katsuhiko
K
Second Department of Internal Medicine, Oita Medical University, Hasama-machi, Oita, 879-5593, Japan.
Yamakami
Yuriko
Y
Mizunoe
Syunji
S
Tokimatsu
Issei
I
Hiramatsu
Kazufumi
K
Nagai
Hiroyuki
H
Kadota
Jun-ichi
J
Nasu
Masaru
M
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D005260:Female; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000209:etiology*; D016706:Still's Disease, Adult-Onset / Q000150:complications*
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone