Severe hyperferritinemia—a clue for severe hepatitis in a patient with adult-onset Still’s disease

Rema Bishara, Yolanda Braun-Moscovici, Amir Dagan, Kohava Toledano, Tarek Saadi, Edmond Sabo, Alexandra Balbir-Gurman*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


A 19-year old previously healthy man developed the adult-onset Still’s disease (AOSD) with high ferritin levels. Corticosteroids induced clinical remission with resolution of fever, arthritis, and rash. While tapering corticosteroids, the patient developed severe liver enzymes elevation, very high ferritin levels and, subsequently, acute liver failure. After other causes of liver disease (infections, metabolic, autoimmune hepatitis, lymphoma, and hemophagocytosis) were excluded, severe hepatitis was attributed to AOSD itself. Cyclosporine induced rapid normalization of liver enzymes and reduction in ferritin levels. Severe hepatitis and very high ferritin levels could be the only manifestation of disease activity in AOSD; therefore, monitoring of liver enzymes and ferritin levels is recommended even after resolution of the clinical symptoms of AOSD. Prompt initiation of cyclosporine can improve liver function and prevent progression to liver failure.

Original languageEnglish
Pages (from-to)795-800
Number of pages6
JournalClinical Rheumatology
Issue number3
StatePublished - 1 Mar 2016
Externally publishedYes


  • Adult-onset Still’s disease
  • Cyclosporine
  • Ferritin
  • Hyperferritinemia
  • Severe hepatitis


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