Aspergillus Pneumonia in a Patient With Adult-Onset Still Disease Successfully Treated With Anakinra

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To the Editor:
Adult-onset Still disease (AOSD) is a complex autoinflammatory disorder of unknown etiology. Key features of AOSD include high spiking fever, arthralgia or arthritis, evanescent skin rash, sore throat, hepatosplenomegaly, leukocytosis with neutrophilia, elevated liver enzymes and erythrocyte sedimentation rate (ESR), and hyperferritinemia with decreased glycosylated ferritin (<20 %). The clinical course of AOSD can be systemic manifestations predominate or articular involvement predominates. Chronic articular involvement can be confused with rheumatoid arthritis (RA).
During the past decade, biologic agents have been considered for the treatment of corticosteroids and disease-modifying antirheumatic drug–refractory cases of AOSD patients in clinical practice. Patients on biologic therapy have a tendency for infections; as a result, nontuberculosis opportunistic infections such as Aspergillus and other fungal infections have been increasingly reported with biologic agents.1,2 Anakinra is a good option for AOSD patients as a primary choice or in refractory cases because of its fast and steroid-sparing effects.3,4 Association between interleukin 1 (IL-1) blockade and risk of Aspergillus infection was shown in molecular studies, but any connection was not shown in clinical practice up to now.5 We report the first case of pulmonary aspergillosis, with anakinra, in a patient with multiple-drug–resistant AOSD.
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