Clinical Rheumatology

, Volume 28, Issue 4, pp 485–487

Glucocorticoid and cyclosporine refractory adult onset Still’s disease successfully treated with tocilizumab

  • Kazuko Matsumoto
  • Takao Nagashima
  • Shino Takatori
  • Yuta Kawahara
  • Masaki Yagi
  • Masahiro Iwamoto
  • Hitoaki Okazaki
  • Seiji Minota
Case Report

DOI: 10.1007/s10067-009-1097-z

Cite this article as:
Matsumoto, K., Nagashima, T., Takatori, S. et al. Clin Rheumatol (2009) 28: 485. doi:10.1007/s10067-009-1097-z

Abstract

We report a 29-year-old Japanese woman with disseminated intravascular coagulation (DIC) and adult onset Still’s disease (AOSD). Her disease was refractory to high-dose glucocorticoids, two courses of steroid pulse therapy, and addition of cyclosporine (3.5 mg/kg/day). The serum interleukin-6 level was markedly elevated. Therefore, we administered an anti-interleukin-6 receptor antibody (tocilizumab, 8 mg/kg fortnightly), which dramatically improved her symptoms and the levels of acute-phase proteins. In addition, rapid tapering of the glucocorticoid dose was possible. Four months later, she was maintained on tocilizumab infusion once a month with low-dose steroid therapy. Cyclosporine is one of the first-line immunosuppressants for AOSD, especially when associated with DIC, hepatic failure, or hemophagocytic syndrome. In patients with cyclosporine-resistant AOSD, tocilizumab may be another useful option.

Keywords

Adult onset Still’s disease Disseminated intravascular coagulation Interleukin-6 Tocilizumab 

Copyright information

© Clinical Rheumatology 2009

Authors and Affiliations

  • Kazuko Matsumoto
    • 1
  • Takao Nagashima
    • 1
  • Shino Takatori
    • 1
  • Yuta Kawahara
    • 1
  • Masaki Yagi
    • 1
  • Masahiro Iwamoto
    • 1
  • Hitoaki Okazaki
    • 1
  • Seiji Minota
    • 1
  1. 1.Division of Rheumatology and Clinical ImmunologyJichi Medical UniversityShimotsuke-shiJapan

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