Anest. intenziv. Med. 2011;22(6):337-342

Severe course of Still's disease with multiple organ failure with predominant liver failureIntesive Care Medicine - Case Report

Kočan Ladislav^1,*, Vašková Janka⁴, Vaško Ladislav⁴, Hoková Hana³, Majerník Miloš¹, Krištofová Beáta², Šimonová Jana¹, Firment Jozef¹

¹ I. klinika anestéziológie a intenzívnej medicíny, UN LP, Košice, SR

² I. interná klinika, UN LP, Košice, SR

³ Klinika anestéziológie, resuscitácie a intenzívnej medicíny ÚVN SNP Ružomberok - FN, SR

⁴ Ústav lekárskej chémie, biochémie a klinickej biochémie, LF UPJŠ, Košice, SR

Still's Disease is a disease of unknown aetiology and pathogenesis. It is characterized by fever, arthritis, salmon-coloured rash and organ failure in severe cases. This is a case report of a 31-year old female patient on long-term steroid treatment who suffered from adult Still's disease. She was admitted to the Clinic of Anaesthesiology and Intensive Care with fever up to 40 °C, unconsciousness and signs of multi-organ failure (liver, acute kidney failure, cardiovascular system, lungs, and disseminated intravascular coagulation). A complex of examinations did not confirm the cause to be sepsis, malignancy, a haematological disease or an infectious disease (repeated blood cultures were negative). We concluded this was an acute exacerbation of adult Still's disease complicated by the syndrome of oversize macrophage activation with secondary multi-organ failure. The patient's condition required pulse steroid therapy, hepato-protective therapy and supplementary nutrition inclusive of parenteral selenium supplementation, antibiotics, mechanical ventilation and extra-corporeal elimination therapy. The therapy continued at the Clinic of Internal Medicine. The complex therapy resulted in great regression of the liver insufficiency. After 28 days of hospitalization the patient was discharged in an improved condition.

Keywords: Still's disease; systemic inflammatory response syndrome; selenium; enteral nutrition; parenteral nutrition; glutathione peroxidase

Received: August 11, 2011; Accepted: November 11, 2011; Published: December 1, 2011  Show citation