CASE REPORT

Successful treatment of a patient with refractory adult Still's disease by tacrolimus

Authors

Kosaku Murakami¹, Takao Fujii¹, Naoichiro Yukawa¹, Hajime Yoshifuji¹, Daisuke Kawabata¹, Masao Tanaka¹, Takashi Usui¹ and Tsuneyo Mimori¹

1. Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan

Received:

31 July 2006

Accepted:

26 December 2006

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Abstract

Adult Still's disease (ASD) is a systemic rheumatic disease characterized by high spiking fever, erythema, polyarthritis, and increased levels of C-reactive protein, ferritin, and interleukin (IL)-18. Recently, biological agents targeting proinflammatory cytokines such as tumor necrosis factor (TNF) α, IL-1, and IL-6 have been described as effective treatments for refractory ASD. Herein, we present a patient with ASD, who was successfully treated by tacrolimus concomitant with corticosteroid, while infliximab and etanercept were not effective. Tacrolimus may be one of the drugs for the ASD patients refractory to the conventional treatments including TNF inhibitors.

Key words

Adult Still's
disease - Interleukin-18 - Interleukin-6 - Tacrolimus - Tumor necrosis factor - Tumor necrosis factor inhibitors