Retrospective monocentric study of 17 patients with adult Still's disease, with special focus on liver abnormalities.
OBJECTIVE
Adult Still's disease is one of the febrile disorders of unknown etiology, characterized by high fever, transient cutaneous rash and leukocytosis. Liver dysfunction in adult Still's disease has been described in some case reports. The objective of this study was to analyze the pattern and the frequency of liver abnormalities in a monocenter series of adult Still's disease patients.


METHODS
Data of 17 patients with adult Still's disease (fulfilling Yamaguchi's diagnostic criteria) were retrospectively reviewed. These patients were followed in an Internal Medicine Department over a period of 7 years.


RESULTS
The median age was 27 years with a sex ratio M/F of 1.4. Fever was present in 100% of the cases and hepatomegaly occurred in 47% of the cases. Abnormalities in liver biochemistry, apparent in 76% of the subjects were characterized from moderate (elevation of transaminases between 2 and 5 N) (65%) to severe cytolysis (level of transaminases > 5 N) (12%), cholestasis (elevation of gamma GT and/or PAL) (65%), and increase in the level of LDH (35%). All of these symptoms disappeared either spontaneously or under treatment (83%), within a median period of 18 days.


CONCLUSIONS
This study confirms the high frequency of liver dysfunction in adult Still's disease patients. Although it is moderate and asymptomatic in most cases, severe cytolytic hepatitis has been described. This study especially puts forward the need for exploring the possibility of adult Still's disease in the presence of a fever and hepatic cytolysis.
Andrès
Emmanuel
E
Department of Internal Medicine, Hôpitaux Universitaires de Strasbourg, France. emmanuel.andres@chru-strasbourg.fr
Kurtz
Jean Emmanuel
JE
Perrin
Anne-Elisabeth
AE
Pflumio
Francis
F
Ruellan
Anne
A
Goichot
Bernard
B
Dufour
Patrick
P
Blicklé
Jean-Frédéric
JF
Brogard
Jean Marie
JM
Schlienger
Jean-Louis
JL
D000328:Adult; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016706:Still's Disease, Adult-Onset / Q000150:complications* / Q000175:diagnosis / Q000628:therapy