{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T15:51:54Z","timestamp":1778946714790,"version":"3.51.4"},"reference-count":9,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Penghu Branch, Tri-Service General Hospital","award":["TSGH-PH-D-109005"],"award-info":[{"award-number":["TSGH-PH-D-109005"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Adult-onset Still\u2019s disease (AOSD) is a rheumatic disease characterized by systemic inflammatory symptoms, including intermittent spiking fever, polyarthritis and a distinctive salmon-colored rash. Corticosteroids are the first-line treatment for AOSD. However, corticosteroids are potentially hepatotoxic in certain cases and may complicate the course of the disease. Materials and Methods: A 29-year-old female suffering from fever of unknown origin for two weeks was diagnosed with AOSD according to Yamaguchi\u2019s criteria. She received corticosteroids as the first-line treatment for AOSD and developed acute severe hepatitis. A diagnostic protocol has been performed. Results: Corticosteroid-induced liver injury was confirmed by clinical observation and rechallenge of the drug in this case. The result of liver biopsy also supported the diagnosis. Mycophenolic acid, a disease-modifying antirheumatic drug (DMARD) was chosen as an alternative treatment. AOSD remission was achieved under this treatment after three months. Conclusions: Severe acute hepatitis induced by corticosteroids, although very rare, may be observed in patients with AOSD. Drug-induced liver injury needs to be kept in mind when unexpected acute hepatitis is found. Mycophenolic acid could be a proper substitute medication in these cases.<\/jats:p>","DOI":"10.3390\/medicina58020191","type":"journal-article","created":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T04:49:51Z","timestamp":1643258991000},"page":"191","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Corticosteroid-Induced Liver Injury in Adult-Onset Still\u2019s Disease"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6302-7487","authenticated-orcid":false,"given":"Chin-Chi","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4630-2103","authenticated-orcid":false,"given":"Yi-Jen","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6202-1382","authenticated-orcid":false,"given":"Chun-Chi","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan"},{"name":"Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsiang-Cheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan"},{"name":"Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0259-0679","authenticated-orcid":false,"given":"Fu-Chiang","family":"Yeh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan"},{"name":"Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan"},{"name":"Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Penghu Branch, Tri-Service General Hospital, Penghu 880, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,27]]},"reference":[{"key":"ref_1","first-page":"424","article-title":"Preliminary criteria for classification of adult Still\u2019s disease","volume":"19","author":"Yamaguchi","year":"1992","journal-title":"J. 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Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1097\/RHU.0b013e3181b57199","article-title":"Liver abnormalities in adult onset Still\u2019s disease: A retrospective study of 77 Chinese patients","volume":"15","author":"Zhu","year":"2009","journal-title":"J. Clin. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"omaa102","DOI":"10.1093\/omcr\/omaa102","article-title":"Acute liver injury in a patient with adult-onset Still\u2019s disease\u2014the challenge of differential diagnosis","volume":"2020","author":"Weber","year":"2020","journal-title":"Oxf. Med Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.3899\/jrheum.121309","article-title":"Subacute liver failure following anakinra treatment for adult-onset still disease","volume":"40","author":"Aly","year":"2013","journal-title":"J. Rheumatol."},{"key":"ref_8","first-page":"964828","article-title":"Tocilizumab-Induced Acute Liver Injury in Adult Onset Still\u2019s Disease","volume":"2013","author":"Drepper","year":"2013","journal-title":"Case Rep. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"656","DOI":"10.5812\/kowsar.1735143X.713","article-title":"Liver Injury Induced by High-Dose Methylprednisolone Therapy: A Case Report and Brief Review of the Literature","volume":"11","author":"Gutkowski","year":"2011","journal-title":"Hepat. Mon."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/2\/191\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:08:35Z","timestamp":1760134115000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/2\/191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,27]]},"references-count":9,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["medicina58020191"],"URL":"https:\/\/doi.org\/10.3390\/medicina58020191","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,27]]}}}