Department of General Internal Medicine, Tenri Hospital, Japan.
Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Japan.
Intern Med. 2022 Dec 15;61(24):3743-3747. doi: 10.2169/internalmedicine.9487-22. Epub 2022 May 7.
We encountered a case of refractory adult-onset Still's disease (AOSD) with two relapses. Prednisolone and methotrexate were begun as induction therapy, resulting in the patient's first relapse during tapering of prednisolone. After the introduction of tocilizumab, she achieved remission. However, she experienced a second relapse following prednisolone tapering. While lactate dehydrogenase (LDH) levels and white blood cell (WBC) counts increased in both relapses, interleukin-6 (IL-6) suppression resulted in stable C-reactive protein and ferritin levels in the second relapse. A comparison of the two relapses indicated that increases in both WBC counts and LDH levels can aid in the diagnosis of AOSD relapse.
我们遇到一例难治性成人Still 病（AOSD），有两次复发。泼尼松龙和甲氨蝶呤作为诱导治疗开始，导致患者在泼尼松龙减量期间首次复发。在使用托珠单抗后，她达到了缓解。然而，在泼尼松龙减量后，她经历了第二次复发。虽然两次复发时乳酸脱氢酶（LDH）水平和白细胞（WBC）计数均升高，但白细胞介素-6（IL-6）抑制导致第二次复发时 C 反应蛋白和铁蛋白水平稳定。两次复发的比较表明，WBC 计数和 LDH 水平的升高有助于 AOSD 复发的诊断。
