A Japanese case of severe refractory adult Still's disease: serum interleukin-18 is a possible marker of the response to low-dose cyclosporin A therapy.

A 22-year-old man was admitted to our hospital with a high fever, fatigue, mild arthritis, and bilateral pleural effusions. Laboratory tests revealed a high ESR, leukocytosis, high serum C-reactive protein level, and high serum ferritin level. Various antibiotics had been given by a local hospital with no response. He was diagnosed as having severe refractory adult Still's disease and was subsequently treated with high-dose steroid therapy and low-dose cyclosporin A. The serum interleukin-18 level was monitored throughout treatment and was found to be a potentially useful marker of disease activity as well as of the response to cyclosporin A therapy.