Adult-onset Still's disease in a patient over 80 years old successfully treated with low-dose methotrexate therapy |
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Authors: | Kurasawa Miwa Kotani Kazuhiko Kurasawa Gotaro Shida Kousuke Yamada Shigeki Tago Toshihiko |
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Affiliation: | Department of Internal Medicine, Nishiagatsuma Welfare Hospital, Naganohara, Japan. miwa-kr@zero.ad.jp |
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Abstract: | We report on an 83-year-old Japanese woman with adult-onset Still's disease (AOSD), with marked hypercytokinemia (serum levels of ferritin (Fer) and interleukin (IL)-18 were markedly high). On seeing older patients with fever of unknown origin (FUO), particularly Asians, AOSD should be considered. Reduced doses of oral prednisolone following intravenous methylprednisolone (mPSL) therapy caused a flare-up of AOSD and led to Pneumocystis carinii (jeroveci) pneumonia. Low-dose methotrexate (MTX) therapy was administered as a steroid-sparing agent with good response. Our case suggests that in very elderly people, as in younger patients, MTX is useful for controlling AOSD with marked hypercytokinemia, and avoiding corticosteroid-induced adverse effects. |
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