title: Severe hyperferritinemia--a clue for severe hepatitis in a patient with adult-onset Still's disease.
abstract: A 19-year old previously healthy man developed the adult-onset Still's disease (AOSD) with high ferritin levels. Corticosteroids induced clinical remission with resolution of fever, arthritis, and rash. While tapering corticosteroids, the patient developed severe liver enzymes elevation, very high ferritin levels and, subsequently, acute liver failure. After other causes of liver disease (infections, metabolic, autoimmune hepatitis, lymphoma, and hemophagocytosis) were excluded, severe hepatitis was attributed to AOSD itself. Cyclosporine induced rapid normalization of liver enzymes and reduction in ferritin levels. Severe hepatitis and very high ferritin levels could be the only manifestation of disease activity in AOSD; therefore, monitoring of liver enzymes and ferritin levels is recommended even after resolution of the clinical symptoms of AOSD. Prompt initiation of cyclosporine can improve liver function and prevent progression to liver failure.
authors.affiliation: B. Shine Rheumatology Unit, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Rema
authors.initials: R
authors.lastname: Bishara
authors.affiliation: B. Shine Rheumatology Unit, Rambam Health Care Campus, Haifa, Israel.|Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Braun-Moscovici
authors.affiliation: B. Shine Rheumatology Unit, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Dagan
authors.affiliation: B. Shine Rheumatology Unit, Rambam Health Care Campus, Haifa, Israel.|Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Kohava
authors.initials: K
authors.lastname: Toledano
authors.affiliation: Liver Unit, Rambam Health Care Campus, Haifa, Israel.|Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Tarek
authors.initials: T
authors.lastname: Saadi
authors.affiliation: Department of Pathology, Rambam Health Care Campus, Haifa, Israel.|Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Edmond
authors.initials: E
authors.lastname: Sabo
authors.affiliation: B. Shine Rheumatology Unit, Rambam Health Care Campus, Haifa, Israel. a_balbir@rambam.health.gov.il.|Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. a_balbir@rambam.health.gov.il.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Balbir-Gurman
mesh_terms: D016572:Cyclosporine / Q000627:therapeutic use; D005293:Ferritins / Q000097:blood*; D006505:Hepatitis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D016706:Still's Disease, Adult-Onset / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D005293:Ferritins
keywords: Adult-onset Still’s disease; Cyclosporine; Ferritin; Hyperferritinemia; Severe hepatitis