Okamoto Osamu, Oishi Masaki, Fujiwara Sakuhei
Dermatology, Department of Anatomy, Biology and Medicine, Faculty of Medicine, Oita University, Oita, Japan.
J Dermatol. 2008 Feb;35(2):106-10. doi: 10.1111/j.1346-8138.2008.00424.x.
A case of steroid-resistant adult-onset Still's disease is herein reported. The patient consulted us because of night fever, arthralgia and evanescent rashes. She was diagnosed with adult-onset Still's disease, with a C-reactive protein (CRP) value of 29.5 mg/dL and serum ferritin level of 4500 ng/mL. The fever, rashes and arthralgia disappeared after medication of medium-dose oral prednisolone, however, the CRP value persisted at high levels, and the serum ferritin level nevertheless increased by 5200 ng/mL. Following the pulse therapy with corticosteroid, the CRP value decreased once but thereafter returned to a high level again. The serum ferritin level did not respond during that therapy. Finally, 10 days after starting the administration of methotrexate, the CRP value dramatically decreased from 7 mg/dL to 0.16 mg/dL, and thereafter the serum ferritin level started to decline, which thus enabled us to eventually taper the dose of oral prednisolone.
本文报告一例类固醇抵抗型成人斯蒂尔病。该患者因夜间发热、关节痛和一过性皮疹前来就诊。她被诊断为成人斯蒂尔病，C反应蛋白（CRP）值为29.5mg/dL，血清铁蛋白水平为4500ng/mL。口服中等剂量泼尼松龙治疗后，发热、皮疹和关节痛消失，但CRP值持续处于高水平，血清铁蛋白水平反而升高了5200ng/mL。糖皮质激素冲击治疗后，CRP值一度下降，但随后又再次回升至高水平。该治疗过程中血清铁蛋白水平无反应。最后，在开始使用甲氨蝶呤治疗10天后，CRP值从7mg/dL急剧降至0.16mg/dL，此后血清铁蛋白水平开始下降，从而使我们最终能够逐渐减少口服泼尼松龙的剂量。
