A case we initiated continuous renal replacement therapy for the purpose of controlling the refractory adult Still’s disease

Abstract

【Background】The core mechanism underlying the pathogenesis of adult Still’s disease is the excessive production of inflammatory cytokines in association with an infection；this results in a loss of control of monocyte and macrophage activation.【Case】An approximately 70-year-old woman was admitted to our hospital because of persistent fever and rash. Oral prednisolone administration was initiated in hopes of reaching a diagnosis. On the 7th day, the patient was diagnosed with adult Still’s disease, and steroid pulse therapy was initiated. The patient’s fever abated immediately, but began reemerging a few days later. Decreased urine volume was also observed at this time. The addition of an immunosuppressive agent to her treatment regimen was ineffective. On the 25th day, continuous renal replacement therapy (CRRT) was initiated for the purpose of removing cytokines, resulting in a prompt reduction in her body temperature. Tocilizumab was used to control the disease condition, and other oral medications such as prednisolone were reduced. The patient was discharged from the hospital on the 58th day, without any recurrence of fever while in hospital. 【Conclusion】Here, we report a case of adult Still’s disease that could be remarkably controlled by a combination of CRRT and tocilizumab therapy. This effect could have been achieved by the adsorption of overproduced cytokines. However, further study is required to substantiate this.