1例成人Still病合并干燥综合征患者发生亚急性药物性肝衰竭报道并文献复习

A Case Report of Subacute Drug-Induced Liver Failure in a Patient with Adult-Onset Still’s Disease Complicated by Sjögren’s Syndrome and Literature Review

摘要: 成人Still病(adult-onset Still’s disease, AOSD)是病因未明的全身炎症性自身免疫病，常表现为发热、皮疹、关节痛等，可合并干燥综合征(Sjögren’s syndrome, SS)等自身免疫性疾病。AOSD合并SS患者因长期使用免疫抑制剂等药物，存在药物性肝损伤风险，而进展为亚急性药物性肝衰竭(subacute drug-induced liver failure, SALF)的情况较为罕见。本文报道1例AOSD合并SS后引发SALF的病例，旨在提高临床医生对该类患者的认识，为疾病的诊断与治疗提供参考。

Abstract: Adult-onset Still’s disease (AOSD) is an idiopathic systemic inflammatory autoimmune disorder. Clinically, it is characterized by fever, rash, and arthralgia. Moreover, it may be complicated with autoimmune diseases such as Sjögren’s syndrome (SS). Patients with AOSD combined with SS are prone to drug-induced liver injury (DILI) because of the long-term use of immunosuppressants. However, the progression to subacute drug-induced liver failure (SALF) is relatively rare. The objective of this study is to report a case of SALF secondary to AOSD complicated with SS and provide reference for clinical diagnosis and treatment. For this purpose, we collected and analyzed the clinical data of the patient. The patient was a middle-aged female who had been diagnosed with AOSD combined with SS for several years and had been receiving long-term immunosuppressant therapy, including methotrexate and corticosteroids. Then, we also reviewed relevant literature. The results showed that after a period of treatment, the patient developed obvious liver function damage, with a significant increase in transaminases and bilirubin, and was finally diagnosed with SALF. After active comprehensive treatment such as liver protection, adjustment of immunosuppressant dosage, and symptomatic support, including the use of liver-protecting drugs like polyene phosphatidylcholine and ademetionine, as well as close monitoring of vital signs and laboratory indicators, the patient’s condition was effectively controlled. In conclusion, clinicians should pay close attention to the risk of DILI in patients with AOSD combined with SS receiving long-term immunosuppressant treatment. Timely monitoring of liver function is essential to detect any abnormalities at an early stage and avoid the progression of severe liver injury, so as to improve the prognosis of patients.