Tocilizumab enables glucocorticoid reduction in refractory adult-onset Still’s disease: A case report and literature review

doi:10.3969/j.issn.1004-583X.2025.11.008

Abstract

Abstract:

Objective To investigate the clinical features, diagnostic challenges, and treatment approaches for refractory adultonset Still’s disease (AOSD). Methods We performed a retrospective analysis of a patient with AOSD complicated by macrophage activation syndrome (MAS) and acute liver failure (ALF), evaluating the clinical response to tocilizumab, an interleukin6 (IL6) receptor antagonist. Relevant literature was reviewed to contextualize the findings. Results A 24-year-old female with AOSD progressed to MAS (HScore 329) and ALF despite highdose corticosteroid therapy. Treatment with tocilizumab combined with plasma exchange led to rapid normalization of body temperature, marked improvement in liver function, and substantial reductions in inflammatory markers. Conclusion This case demonstrates that tocilizumab can induce rapid remission in refractory AOSD complicated by MAS or ALF and facilitate tapering of glucocorticoids; however, its longterm safety in this setting require further study.

Key words: adult-onset Still's disease, macrophage activation syndrome, hepatic failure, tocilizumab

CLC Number:

R593.2

Luo Lunju, Deng Yiyao, Li Zhengsheng, Xue Qiuling, Zha Yan, Yuan Jing. Tocilizumab enables glucocorticoid reduction in refractory adult-onset Still’s disease: A case report and literature review[J]. Clinical Focus, 2025, 40(11): 1016-1021.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2025.11.008

https://www.lchc.cn/EN/Y2025/V40/I11/1016

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References 35

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