Q J Med 2001; 94: 568-569
© 2001 Association of Physicians
Correspondence |
Liver biopsy is not useful in the diagnosis of adult Still's disease
Department of Internal Medicine, Hôpitaux Universitaires of Strasbourg
Department of Pathology, Hôpitaux Universitaires of Strasbourg
Department of Medicine, Centre Hospitalier Général of Saverne, France
Sir,
Liver biopsy is usually the most specific test to assess the nature and the severity of numerous liver diseases (reviewed in reference 1). In addition, it can be useful in diagnosing or monitoring chronic fever or several inflammatory disorders, particularly in case of liver abnormalities.2 However, it is debatable whether this examination has any utility in the diagnosis or management of Still's disease in adults.
We performed percutaneous liver biopsy in five patients with a retrospectively established diagnosis of adult Still's disease, with regard to Yamaguchi's criteria.3 All five patients were febrile, had evanescent maculopapular rash, leukocytosis and chronic liver abnormalities, particularly moderate hepatomegaly and high serum alanine aminotransferase levels (between 2- and 5-fold the normal level) (partial data in reference 4).
In all the patients, percutaneous liver biopsy was done under local anaesthesia and controlled by ultrasonography. No major complications were reported. Transient localized pain at the biopsy site was observed in two patients, requiring low paracetamol doses.
Analysis of the liver biopsy specimen showed non-specific lesions in three cases, with moderate inflammation within portal spaces in two patients and polymorphic inflammatory infiltrate of the biliary canaliculus in one patient (as seen in early primary biliary cirrhosis lesions, grade 1). No pathological liver abnormality was observed in two patients. In no patients did liver specimen analysis suggest or support the diagnosis of adult Still's disease.
Liver biopsy provides an accurate diagnosis in approximately 90% of patients with unexplained abnormalities revealed on liver function tests.1 Thus, liver biopsy can lead to the diagnosis of systemic disorders that can affect the liver (e.g. sarcoidosis, amyloidosis) or infectious disease (e.g. immunodeficiency syndrome, tuberculosis). In adult Still's disease diagnosis, its utility is undetermined. No consistent data, only case reports, have been reported in the literature.5 Our experience of this technique in the diagnosis of adult Still's disease with persistent biological liver abnormalities was negative. Its only interest was in ruling out the possibility of hepatitis B and C, diseases that may be exacerbated by treatments for adult Still's disease such as steroids or immunomodulatory agents (methotrexate).
References
1.
Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med2001; 344:495–500.
2. Nolan SM, Fitzgerald FT. Fever of unknown origin: the general internist's approach. Postgrad Med1987; 81:190–8; 203–5.
3. Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H, et al. Preliminary criteria for classification of adult Still's disease. J Rheumatol1992; 19:424–30.[Web of Science][Medline]
4. Andrès E, Ruellan A, Pflumio F, Perrin AE, Goichot B, Grunenberger F, et al. Maladie de Still de l’adulte: une étiologie méconnue de cytolyse hépatique aiguë fébrile: etude de douze malades. Gastroenterol Clin Biol2001; 25:353–5.[Medline]
5. Kahn MF, Delaire M. Maladie de Still de l’adulte. In: Kahn MF, Peltier AP, Meyer O, Piette C, eds. Maladies systémiques. Paris, Flammarion Médecine-Sciences, 1991:231–8.
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