title: [Simultaneous relapse of Basedow's disease in a patient with adult-onset Still's disease].
abstract: This report describes a 50-year-old woman with coexisting Basedow's disease and adult-onset Still's disease (AOSD) that relapsed simultaneously. She was diagnosed with Basedow's disease in 1999, and treatment with antithyroid agents was started. However, the treatment was soon stopped because of severe side effects. A partial thyroidectomy was performed and the thyroid function stayed well-controlled after the surgery. In August 2007, she was admitted to our hospital with fever, a sore throat, skin rashes, arthritis and leukocytosis, and was diagnosed with AOSD. At the same time, her laboratory data revealed decreased serum TSH and elevated serum free T4, suggesting a relapse of Basedow's disease. After initiation of steroid pulse therapy accompanied by oral prednisolone, both diseases improved significantly. Prednisolone was gradually reduced, and the disease activity remained in remission. Immediately after prednisolone reached 3 mg/day in November 2009, both diseases relapsed. Prednisolone was increased to 30 mg/day, and the diseases became well-controlled again. In this case, Basedow's disease was aggravated when AOSD was in the active stage. Literature searches revealed five previously reported cases with coexisting Basedow's disease and AOSD. In four of the six cases, including our case, both diseases were activated simultaneously. AOSD in the active stage is known to cause hypercytokinemia and immunological derangement. Our case indicated that the pathogenesis of AOSD might lead to relapse of coexisting Basedow's disease.
authors: Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
authors: Masataka
authors: M
authors: Torigoe
authors: Tomoya
authors: T
authors: Miyamura
authors: Masataka
authors: M
authors: Nakamura
authors: Yoshirou
authors: Y
authors: Hourai
authors: Yoshie
authors: Y
authors: Hirata
authors: Jin
authors: J
authors: Ando
authors: Soichiro
authors: S
authors: Takahama
authors: Rumi
authors: R
authors: Minami
authors: Masahiro
authors: M
authors: Yamamoto
authors: Eiichi
authors: E
authors: Suematsu
mesh_terms: D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D020551:Pulse Therapy, Drug; D012008:Recurrence; D016706:Still's Disease, Adult-Onset / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D011239:Prednisolone; D008775:Methylprednisolone