Adult-onset Still's disease in a patient over 80 years old successfully treated with low-dose methotrexate therapy.
We report on an 83-year-old Japanese woman with adult-onset Still's disease (AOSD), with marked hypercytokinemia (serum levels of ferritin (Fer) and interleukin (IL)-18 were markedly high). On seeing older patients with fever of unknown origin (FUO), particularly Asians, AOSD should be considered. Reduced doses of oral prednisolone following intravenous methylprednisolone (mPSL) therapy caused a flare-up of AOSD and led to Pneumocystis carinii (jeroveci) pneumonia. Low-dose methotrexate (MTX) therapy was administered as a steroid-sparing agent with good response. Our case suggests that in very elderly people, as in younger patients, MTX is useful for controlling AOSD with marked hypercytokinemia, and avoiding corticosteroid-induced adverse effects.
Kurasawa
Miwa
M
Department of Internal Medicine, Nishiagatsuma Welfare Hospital, Naganohara, Japan. miwa-kr@zero.ad.jp
Kotani
Kazuhiko
K
Kurasawa
Gotaro
G
Shida
Kousuke
K
Yamada
Shigeki
S
Tago
Toshihiko
T
D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D016207:Cytokines / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D016207:Cytokines; D008775:Methylprednisolone; D008727:Methotrexate