Michel M, Hayem G, Rat A C, Meyer O, Palazzo E, Blétry O, Kahn M F
Clinique de rhumatologie, CHU Bichat-Claude-Bernard, Paris, France.
Rev Med Interne. 1996;17(5):407-9. doi: 10.1016/0248-8663(96)83741-6.
If adult Still's disease (ASD) can sometimes lead to severe destructive joint lesions and to various systemic manifestations, life-threatening complications are very rare. However, a long-term and high-dose corticosteroid therapy is often required to control the disease, with frequent corticodependence. Some authors have proposed methotrexate as a second line drug for ASD, that could permit a corticosteroid sparing effect. We report two cases of acute fatal infectious complications--legionella pneumonitis and multiple brain abscess caused by Nocardia asteroides--in two patients treated for ASD with both corticosteroids and methotrexate. These two cases raise the problem of the immunodepression induced by this combination therapy and point out the difficulties in aggressive forms of ASD.
如果成人斯蒂尔病（ASD）有时会导致严重的破坏性关节病变和各种全身表现，那么危及生命的并发症则非常罕见。然而，通常需要长期大剂量使用皮质类固醇激素疗法来控制病情，且常常会出现皮质类固醇依赖。一些作者提议将甲氨蝶呤作为ASD的二线药物，这可能会产生皮质类固醇减量效应。我们报告了两例急性致命性感染并发症的病例——两例接受皮质类固醇激素和甲氨蝶呤治疗的ASD患者分别发生了军团菌肺炎和由星形诺卡菌引起的多发性脑脓肿。这两例病例引发了联合治疗所致免疫抑制的问题，并指出了侵袭性ASD治疗中的困难。
