Subacute Liver Failure Following Anakinra Treatment for Adult-onset Still Disease

Abstract

To the Editor: Anakinra is approved for the treatment of rheumatoid arthritis and it is used off-label for various other rheumatic diseases1. Although beneficial effects of anakinra on liver inflammation and regeneration have been shown2, we describe a case of subacute liver failure in a patient with adult-onset Still disease (AOSD) who had been treated with anakinra monotherapy. Three months before admission to our hospital, the 20-year-old man had been diagnosed with AOSD. Initial treatment consisted of anakinra 100 mg and prednisolone 100 mg daily. The latter had been tapered to 10 mg after achieving remission 1 week before the first symptoms of liver failure appeared. The patient developed fever and jaundice. C-reactive protein was increased to 42 mg/dl, immunoglobulin E (IgE) was elevated to 709 kU/l, and transaminases were substantially increased, with alanine transaminase levels of 1128 U/l (Figure 1a). With an INR of 2.7, coagulation was massively disturbed. Figure 1. Development of the clinical course and hematoxylin and eosin stainings of the liver biopsy. (a) Development of alanine transaminase (ALT, U/l), bilirubin … Address correspondence to Dr. Benten; E-mail: d.benten{at}uke.de