Fulminant hepatitis requiring MARS and liver transplantation in a patient with Still's disease

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology and pathogenesis. The disease usually presents with high spiking fever, evanescent rash, polyarthralgias or polyarthritis, sore throat, hepatosplenomegaly, lymphadenopathy, polynuclear leukocytosis, liver cytolysis, and a high serum level of ferritin with a low glycosylated fraction [1]. Abnormalities in liver tests, like a moderate elevation of transaminases and cholestasis, are common but usually resolve either spontaneously or rapidly under medical treatment [2]. However, rare cases of severe liver dysfunction in AOSD have been reported [2]. We describe a case of fulminant liver failure (FLF) in a patient with a recently diagnosed AOSD who was successfully treated with molecular absorbent recirculating system (MARS), followed by urgent liver transplantation (LT).