title: Acute Severe Hepatitis and Hemophagocytosis in Adult Onset Still's Disease.
abstract: We report a 44-year-old male Turkish patient with adult onset Still's disease (AOSD) complicated by acute severe hepatitis and hemophagocytosis. Initial investigations for fever and rapidly progressive elevation of liver function tests were not diagnostic. Routine evaluations of liver and bone marrow biopsies missed the fundamental pathology. Extremely elevated ferritin levels led to a more detailed search, and immunohistochemical staining with CD68 for macrophages revealed extensive hemophagocytosis in both the first and second bone marrow biopsies, as well as in the liver biopsy. Treatment with steroid and cyclosporine A induced complete remission.
authors.affiliation: Istanbul Faculty of Medicine, Department of Internal Medicine, Istanbul.
authors.forename: Tuncay
authors.initials: T
authors.lastname: Sahutoglu
authors.affiliation: Yedikule Chest Diseases and Surgery Education and Research Hospital, Chest Medicine, Istanbul.
authors.forename: Elif
authors.initials: E
authors.lastname: Kara
authors.affiliation: Istanbul Faculty of Medicine, Department of Pathology, Istanbul.
authors.forename: Ibrahim Oner
authors.initials: IO
authors.lastname: Dogan
authors.affiliation: Istanbul Faculty of Medicine, Department of Pathology, Istanbul.
authors.forename: Mine
authors.initials: M
authors.lastname: Gulluoglu
authors.affiliation: Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, Istanbul.
authors.forename: Filiz
authors.initials: F
authors.lastname: Akyuz
authors.affiliation: Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, Istanbul.
authors.forename: Fatih
authors.initials: F
authors.lastname: Besisik
mesh_terms: D000208:Acute Disease; D000328:Adult; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D001853:Bone Marrow / Q000473:pathology*; D016572:Cyclosporine / Q000627:therapeutic use; D005293:Ferritins / Q000097:blood*; D006505:Hepatitis / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D012074:Remission Induction; D013256:Steroids / Q000627:therapeutic use; D016706:Still's Disease, Adult-Onset / Q000175:diagnosis* / Q000188:drug therapy; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D016572:Cyclosporine; D005293:Ferritins; D013256:Steroids; C067980:CD68 antigen, human; D000097382:CD68 Molecule