Interleukin 18 and hepatocyte growth factor in fulminant hepatic failure of adult onset Still's disease.

Adult onset Still's disease (AOSD) is a rheumatoid disorder characterized by polyarthritis, intermittent high fever, and salmon colored rashes. Liver dysfunction is usually mild and fulminant liver failure is rare. We describe a 20-year-old woman with AOSD and severe hepatic necrosis leading to hepatic failure requiring liver transplant. This severe liver disorder developed after decreases in fever, arthritis, and C-reactive protein. Interleukin 18 (IL-18), but not ferritin, increased in association with liver dysfunction. Hepatocyte growth factor (HGF) increased at the time of hepatic failure. IL-18 and HGF elevation may have contributed to this rare severe liver injury in AOSD.