Still Disease and the Liver—An Underappreciated Association

Liver dysfunction is common in adult-onset Still disease (AOSD); indeed, liver dysfunction is one of the diagnostic criteria described by Yamaguchi and colleagues.1 Among the collagen vascular diseases, AOSD is associated with the highest incidence of liver dysfunction, with a reported range of 35—85%.2 Liver involvement in AOSD can vary from asymptomatic aminotransferase elevations to life-threatening fulminant hepatic failure (FHF) requiring liver transplantation (LT). Liver dysfunction and FHF may occur at the time of AOSD diagnosis, during the corticosteroid taper, or many years after diagnosis when symptoms are well controlled.3,4 In the case by Hogan and colleagues, the authors describe a case of AOSD with severe hepatic dysfunction that was successfully treated with parenteral corticosteroid therapy; had this therapy not been successful, this patient could have developed FHF and had a poor outcome.5 This case highlights some pertinent issues for clinicians who manage these complex and potentially fatal cases.