Adult-onset Still's disease is a systemic inflammatory disorder with a highly variable clinical course. Mild hepatitis and anemia are common manifestations. We describe a patient with adult Still's disease who developed a severe hepatitis and a life-threatening pure red cell aplasia. The hepatitis developed after treatment with NSAIDs was started. The patient was successfully treated with a combination of prednisone, cyclosporin, and methotrexate. Physicians should be aware that severe hepatitis and pure red cell aplasia can occur in adult Still's disease. We recommend a careful monitoring of liver functions in patients with adult Still's disease who are being treated with NSAIDs.

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Digestive Diseases and Sciences
Department of Internal Medicine

Janssen, H.L.A, van Laar, J.M, van Hoek, B, den Ottolander, G.J, van Krieken, J.H.J.M, & Breedveld, F.C. (1999). Severe hepatitis and pure red cell aplasia in adult Still's disease: Good response to immunosuppressive therapy. Digestive Diseases and Sciences, 44(8), 1639–1642. doi:10.1023/A:1026631514623