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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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