Successful management of Still’s disease with severe liver injury through the administration of baricitinib: a case report

Still’s disease (SD) is a rare systemic autoinflammatory disorder of unknown etiology, clinically characterized by a triad of high-spiking fevers, an evanescent salmon-colored rash, and arthritis. The disease exhibits considerable heterogeneity, ranging from mild manifestations to severe, life-threa...

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Main Authors: Dabin Tang, Yubao Jiang, Yanying Zhang, Jingjing Xie, Jianyong Zhang
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Medicine
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Online Access:https://www.frontiersin.org/articles/10.3389/fmed.2025.1591431/full
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Summary:Still’s disease (SD) is a rare systemic autoinflammatory disorder of unknown etiology, clinically characterized by a triad of high-spiking fevers, an evanescent salmon-colored rash, and arthritis. The disease exhibits considerable heterogeneity, ranging from mild manifestations to severe, life-threatening complications such as macrophage activation syndrome (MAS). Management strategies are tailored according to disease severity, with glucocorticoids remaining the mainstay of treatment for moderate to severe cases. However, a subset of patients becomes glucocorticoid-dependent or refractory, necessitating the use of steroid-sparing immunosuppressive agents. Recent advancements in biologic therapies have significantly improved disease outcomes and are increasingly adopted as first-line therapies. The Janus kinase-signal transducer and activator of transcription (JAK–STAT) signaling pathway, known to be activated in various autoimmune and inflammatory conditions, has emerged as a promising therapeutic target. Herein, we present a case of SD complicated by severe liver injury, which was successfully managed with baricitinib following the failure of conventional synthetic disease-modifying antirheumatic drugs.
ISSN:2296-858X