title: Anakinra-Induced Acute Liver Failure in an Adolescent Patient with Still's Disease.
abstract: The interleukin-1 (IL-1) family consists of 11 cytokines that play key regulatory roles in many immune and inflammatory processes. Anakinra (Kineret, Amgen, Inc.) is an IL-1 receptor antagonist (IL-1ra). Increased levels of IL-1 are found in several disease states suggesting that anakinra may be beneficial in disorders associated with elevated IL-1 levels. Anakinra has been effectively used in the treatment of systemic juvenile idiopathic arthritis and adult-onset Still's disease (AOSD). Despite its therapeutic benefits, anakinra also has potential side effects, including hepatotoxicity. We present a case of AOSD in an adolescent male that was treated with anakinra. During treatment, the patient developed acute liver failure that resolved upon withdrawal of anakinra. Although anakinra-induced liver injury has been reported in adults, including one case of subacute liver failure, we believe our case is the first to show severe acute liver failure in an adolescent treated with anakinra. This case provides significant insight into a potentially serious complication associated with anakinra. It is important to further delineate these complications as the treatment indications for this drug expand.
authors.affiliation: Lurie Children's Hospital of Chicago, Chicago, Illinois.|Columbia University Medical Center, New York, New York.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Taylor
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Vittorio
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Martinez
authors.affiliation: Columbia University Medical Center, New York, New York.|Barnes-Jewish Hospital, St Louis, Missouri.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Fester
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Lagana
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lobritto
authors.affiliation: Columbia University Medical Center, New York, New York.|Children's Hospital at Montefiore, Bronx, New York.
authors.forename: Nadia
authors.initials: N
authors.lastname: Ovchinsky
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000009:adverse effects* / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects / Q000473:pathology; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors
chemical_list: D053590:Interleukin 1 Receptor Antagonist Protein; D017472:Receptors, Interleukin-1
keywords: adult onset Still's disease; anakinra; drug-induced liver injury; liver failure