Case Report

Interleukin 18 and Hepatocyte Growth Factor in Fulminant Hepatic Failure of Adult Onset Still's Disease

ATSUSHI OGATA, MASAYASU KITANO, JYUNICHI YAMANAKA, TOMOKO YAMASAKI, NAOAKI HASHIMOTO, TSUYOSHI IWASAKI, TERUAKI HAMANO, JIRO FUJIMOTO, and EIZO KAKISHITA

ABSTRACT.

Adult onset Still's disease (AOSD) is a rheumatoid disorder characterized by polyarthritis, intermittent high fever, and salmon colored rashes. Liver dysfunction is usually mild and fulminant liver failure is rare. We describe a 20-year-old woman with AOSD and severe hepatic necrosis leading to hepatic failure requiring liver transplant. This severe liver disorder developed after decreases in fever, arthritis, and C-reactive protein. Interleukin 18 (IL-18), but not ferritin, increased in association with liver dysfunction. Hepatocyte growth factor (HGF) increased at the time of hepatic failure. IL-18 and HGF elevation may have contributed to this rare severe liver injury in AOSD. (J Rheumatol 2003;30:1093-6)

Key Indexing Terms:

ADULT ONSET STILL'S DISEASE
FULMINANT HEPATIC FAILURE
LIVER TRANSPLANT
INTERLEUKIN 18
HEPATOCYTE GROWTH FACTOR

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From the Division of Clinical Immunology, Department of Internal Medicine, and the First Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.

A. Ogata, MD, PhD, Assistant Professor of Clinical Immunology; M. Kitano, MD, Postgraduate Student of Clinical Immunology; J. Yamanaka, MD, PhD, Assistant Professor, First Department of Surgery; T. Yamasaki, MD, Resident Physician of Internal Medicine; N. Hashimoto, MD, Clinical Fellow of Clinical Immunology; T. Iwasaki, MD, PhD, Assistant Professor of Clinical Immunology, T. Hamano, MD, PhD, Clinical Professor and Division Chief of Clinical Immunology; J. Fujimoto, MD, PhD, Professor, First Department of Surgery; E. Kakishita, MD, PhD, Professor and Chairman Division of Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo 663-8131, Japan. E-mail: a-ogata@hyo-med.ac.jp

Address reprint requests to Dr. A. Ogata, Division of Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8131, Japan. E-mail: a-ogata@hyo-med.ac.jp

Submitted April 8, 2002; revision accepted October 31, 2002.

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