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Refractory adult-onset Still disease complicated by macrophage activation syndrome and acute myocarditis: A case report treated with high doses (8mg/kg/d) of anakinra.
- Publication Year :
- 2017
-
Abstract
- Rationale: Myocarditis is a rare but potentially fatal complication of Still's disease (about 7% of total cases). Patient concerns: A 42-year-old woman was admitted to our ward with high-grade fever, rash and polyarthralgia, lasting since 4 weeks and rapidly complicated by MAS and acute heart failure. Diagnoses: Adult Onset Still's Disease rapidly developping macrophage activation syndrome and disseminated intravascular coagulopathy, further complicated by iperacute myocarditis with cardiac arrest. Interventions: After failure of conventional therapies (steroids plus cyclosporine and then biological therapy with Anakinra 100 mg/day), the patient was treated with anakinra 100 mg sc 1 fl 4 times a day. Outcomes: Fast clinical and laboratoristic improvement and subsequent disease remission with complete recovery of cardiac function. Lessons: This is the first case report in which high doses of Anakinra have been used to treat a refractory AOSD complicated by MAS and myocarditis. In AOSD complicated by life-threatening conditions, probably we need to consider aggressive therapeutic approaches with higher doses of Il-1 receptor blocker to switch off the hyper-inflammation.
Details
- Database :
- OAIster
- Notes :
- Parisi, Federico, Paglionico, Annamaria, Varriano, Valentina, Ferraccioli, Gianfranco, Gremese, Elisa, Parisi, Federico, Paglionico, Annamaria, Varriano, Valentina, Ferraccioli, Gianfranco (ORCID:0000-0001-6246-2428), Gremese, Elisa (ORCID:0000-0002-2248-1058)
- Publication Type :
- Electronic Resource
- Accession number :
- edsoai.on1105034296
- Document Type :
- Electronic Resource