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| Abstract |
We report the case of a 31-year-old woman who developed adult-onset Still's disease (AOSD) with a high level of serum interleukin (IL)-18. Although treated with high dose steroids, she suffered repeat...ed remissions and her condition deteriorated. After we administered oral cyclosporine A (CsA), 200 mg/d, monitoring C2 and trough levels, her symptoms improved significantly. We decreased the dose of methylprednisolone slowly without noting a relapse. The use of CsA accompanied by C2 and trough level monitoring should be considered for refractory AOSD patients with high levels of serum IL-18.
症例は31歳，女性．2009 年7 月より発熱，発疹，咽頭痛，頚部リンパ節腫脹が出現し当科紹介入 院．入院時検査成績CRP 5.44mg/dl，WBC 9,400/μl，AST 137IU/l，ALT 127IU/l，LDH 722IU/l， 血清IL-18 > 5,000/ml を認め成人発症スチル病（AOSD）と診断．プレドニゾロン（PSL）50mg/日投与を開始し症状は一旦軽快したが，PSL 減量に伴い再燃を認めた．難治性のAOSD と診断しステロイドパルス療法を施行後，シクロスポリン（CsA）200mg/日の投与を開始（血中濃度投与後２時間値965ng/ml，トラフ値98ng/ml)．以後症状は軽快し，コントロール良好である．血清IL-18 高値を呈し，治療抵抗性のAOSD にはC2 をモニタリングしたうえで，十分量のCsA を投与することが有効な治療法と考えられた．show more
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