Severe course of Still’s disease with multiple organ failure with predominant liver failure
Authors:
Kočan Ladislav 1; Vašková Janka 4; Vaško Ladislav 4; Hoková Hana 3; Majerník Miloš 1; Krištofová Beáta 2; Šimonová Jana 1; Firment Jozef 1
Authors place of work:
I. klinika anestéziológie a intenzívnej medicíny, UN LP, Košice, SR
1; I. interná klinika, UN LP, Košice, SR
2; Klinika anestéziológie, resuscitácie a intenzívnej medicíny ÚVN SNP Ružomberok – FN, SR
3; Ústav lekárskej chémie, biochémie a klinickej biochémie, LF UPJŠ, Košice, SR
4
Published in the journal:
Anest. intenziv. Med., 22, 2011, č. 6, s. 337-342
Category:
Intesive Care Medicine - Case Report
Summary
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.
Key words:
Still’s disease – systemic inflammatory response syndrome – selenium – enteral nutrition – parenteral nutrition – glutathione peroxidase
Zdroje
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Štítky
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineČlánok vyšiel v časopise
Anaesthesiology and Intensive Care Medicine
2011 Číslo 6
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