Adult-onset Still's disease in a patient over 80 years old successfully treated with low-dose methotrexate therapy

• Published in: Age and Ageing Vol. 36; no. 1; pp. 104 - 106
• Main Authors: Kurasawa, Miwa, Kotani, Kazuhiko, Kurasawa, Gotaro, Shida, Kousuke, Yamada, Shigeki, Tago, Toshihiko
• Format: Report
• Language: English
• Published: Oxford University Press 01.01.2007
• Subjects: adult-onset Still's disease; elderly; hypercytokinaemia; Japanese; low-dose methotrexate; pulse methylprednisolone; super-old patients
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afl128

We report on an 83-year-old Japanese woman with adult-onset Still's disease (AOSD), with marked hypercytokinemia (serum levels of ferritin (Fer) and interleukin (IL)-18 were markedly high). On seeing older patients with fever of unknown origin (FUO), particularly Asians, AOSD should be considered. Reduced doses of oral prednisolone following intravenous methylprednisolone (mPSL) therapy caused a flare-up of AOSD and led to Pneumocystis carinii (jeroveci) pneumonia. Low-dose methotrexate (MTX) therapy was administered as a steroid-sparing agent with good response. Our case suggests that in very elderly people, as in younger patients, MTX is useful for controlling AOSD with marked hypercytokinemia, and avoiding corticosteroid-induced adverse effects.