To the Editor:
Anakinra is approved for the treatment of rheumatoid arthritis and it is used off-label for various other rheumatic diseases1. Although beneficial effects of anakinra on liver inflammation and regeneration have been shown2, we describe a case of subacute liver failure in a patient with adult-onset Still disease (AOSD) who had been treated with anakinra monotherapy.
Three months before admission to our hospital, the 20-year-old man had been diagnosed with AOSD. Initial treatment consisted of anakinra 100 mg and prednisolone 100 mg daily. The latter had been tapered to 10 mg after achieving remission 1 week before the first symptoms of liver failure appeared. The patient developed fever and jaundice. C-reactive protein was increased to 42 mg/dl, immunoglobulin E (IgE) was elevated to 709 kU/l, and transaminases were substantially increased, with alanine transaminase levels of 1128 U/l (Figure 1a). With an INR of 2.7, coagulation was massively disturbed.
Address correspondence to Dr. Benten; E-mail: d.benten{at}uke.de