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Case Reports in Rheumatology
Volume 2015, Article ID 163952, 5 pages
http://dx.doi.org/10.1155/2015/163952
Case Report

Successful Treatment with Intravenous Cyclophosphamide for Refractory Adult-Onset Still’s Disease

1Department of General Internal Medicine and Rheumatology, Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8562, Japan
2Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8562, Japan
3Department of Hematology, Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8562, Japan
4Department of Pathology, Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8562, Japan
5Department of Rheumatology, Nagasaki University Hospital, Nagasaki 852-8121, Japan

Received 4 November 2015; Revised 4 December 2015; Accepted 8 December 2015

Academic Editor: Jamal Mikdashi

Copyright © 2015 Yoshika Tsuji et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a 64-year-old female case of intractable adult-onset Still’s disease (AOSD). Initial high-dose steroid therapy combined with cyclosporin A was ineffective against macrophage-activation syndrome (MAS), which was accompanied by the systemic type of AOSD. Treatment for MAS with intravenous cyclophosphamide resulted in remission of AOSD and a reduction in the high doses of steroids. Efficacy of biologics against MAS in AOSD is unclear. Cyclophosphamide, a conventional cytotoxic agent, should be considered as one of the therapeutic options for refractory types of AOSD with MAS.