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Age and Ageing Advance Access originally published online on December 6, 2006
Age and Ageing 2007 36(1):104-106; doi:10.1093/ageing/afl128
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Copyright © The Author 2007. Published by Oxford University Press on behalf of the British Geriatrics Society.

Case Reports

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

Miwa Kurasawa1, Kazuhiko Kotani2, Gotaro Kurasawa1, Kousuke Shida3, Shigeki Yamada4 and Toshihiko Tago5

1 Department of Internal Medicine, Nishiagatsuma Welfare Hospital, Naganohara, Japan
2 Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago, Japan
3 Department of Orthopaedics, Nishiagatsuma Welfare Hospital, Naganohara, Japan
4 Department of Pathology, Omiya Medical Centre, Jichi Medical University, Omiya, Japan
5 Department of Surgery, Nishiagatsuma Welfare Hospital, Naganohara, Japan

Address correspondence to: M. Kurasawa. Tel: (+81)-279-83-7111 Fax: (+81)-279-83-8032. Email: miwa-kr{at}zero.ad.jp

Abstract

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.

Keywords: adult-onset Still's disease, super-old patients, Japanese, hypercytokinaemia, pulse methylprednisolone, low-dose methotrexate, elderly

Received 30 April 2006; accepted in revised form 1 September 2006.


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