A patient with predominantly untreated Still's disease developed chronic necro-inflammatory liver disease over a 10-year period. Clinical and biochemical parameters of her liver disease were largely divergent from the systemic features of her Still's disease. Chronic liver disease has not been previously reported in association with Still's disease, although hepatic dysfunction is a recognized concomitant of Still's disease.
CASE REPORT
A 23-year-old7 obese, black woman, whose course is summarized in Table 1 and Figure 1, has had an 11-year history of fever and abnormal results on liver function tests. In 1969, at the age of 12, she was evaluated at another hospital for a generalized urticari-a1 rash; double-quotidian temperature to 105" F; generalized joint swelling, primarily involving wrists, knees, and ankles; pharyngitis; cervical adenopathy ; and abdominal pain. A diagnosis of juvenile rheumatoid arthritis was made. Hepatic dysfunction was manifested by elevated liver enzymes and hyperbilirubinemia without jaundice. She had an initial 2-month course of prednisone, but her nondeforming polyarticular arthritis persisted for several years and involved her knees, ankles, hands, and wrists. The patient received no other prescription medication and denied using any other drugs during this time. In 1973 she developed jaundice, nausea and vomiting, and markedly elevated serum transaminases; she was otherwise asymptomat-