DOI: 10.12890/2024_004788

Intravenous anakinra for treating macrophage activation syndrome in adult onset still’s disease

Authors

  • Berivan Bitik Department of Internal Medicine, Division of Rheumatology, Baskent University, Ankara, Turkey
  • Mustafa Şenturk Department of Internal Medicine, Faculty of Medicine, Baskent University, Ankara, Turkey
  • Seda Kibaroglu Department of Neurology, Faculty of Medicine, Baskent University, Ankara, Turkey
  • Tulin Yildirim Department of Radiology, Baskent University, Ankara, Turkey
  • Mehmet Engin Tezcan Department of Internal Medicine, Division of Rheumatology, Kartal Training and Research Hospital, Istanbul, Turkey
  • Pınar Zeyneloglu Department of Anaesthesiology and Reanimation, Baskent University, Ankara, Turkey
  • Ahmet Eftal Yucel Department of Internal Medicine, Division of Rheumatology, Baskent University, Ankara, Turkey

berivanbitik@hotmail.com

Keywords

Intravenous anakinra, adult-onset Still’s disease, macrophage activation syndrome

Abstract

Background: Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disease characterized by fever, rash, arthritis, and multi-organ involvement. Macrophage activation syndrome (MAS), a serious complication of AOSD, poses significant diagnostic and therapeutic challenges.
Case Presentation: A 32-year-old male was diagnosed with AOSD in 2020 after being hospitalized for a fever of unknown origin and elevated liver enzymes. The patient was initially treated with corticosteroids and methotrexate but subsequently discontinued both treatment and follow-up. In September 2023, he presented with fever, sore throat, and elevated inflammatory markers. After screening for infections, methylprednisolone (MP) treatment was initiated because of AOSD activation. The following day, the patient was admitted to the intensive care unit due to an altered state of consciousness. Brain magnetic resonance imaging revealed brainstem involvement. Empirical treatments were initiated, including intravenous MP, and immunoglobulin therapy. Due to suspected macrophage activation syndrome (MAS), anakinra (ANA) infusion was initiated. Significant improvement was observed after the ANA infusion.
Conclusion: This case highlights the complex management of severe AOSD complications, emphasizing the role of early recognition, aggressive therapy, and multidisciplinary care in improving outcomes.

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References

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Published

2024-10-10

Issue

Vol. 11 No. 11 (2024)

Categories

How to Cite

1.
Bitik B, Şenturk M, Kibaroglu S, Yildirim T, Tezcan ME, Zeyneloglu P, et al. Intravenous anakinra for treating macrophage activation syndrome in adult onset still’s disease. EJCRIM [Internet]. 2024 Oct. 10 [cited 2026 Nov. 3];11(11). Available from: https://ejcrim.com/index.php/ejcrim/article/view/4788

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