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We report a case of adult-onset Still’s disease (AOSD) with rapid deterioration of cardiac function when treated with recombinant human interleukin (IL) 1 receptor antagonist. Pro-inflammatory cytokines such as IL 1 and tumour necrosis factor (TNF) have been implicated in the pathogenesis of cardiac dysfunction, partly because of their negative inotropic activities in vitro and in vivo.1–3 This concept led to clinical trials evaluating the utility of TNF inhibitors in patients with congestive heart failure. Surprisingly, TNF blockade considerably increased the incidence of cardiac death. On the basis of these observations, TNF inhibitors are usually discontinued in patients with cardiac dysfunction.4,5 However, there is no information on the risks of other cytokine inhibitors.
A 29-year-old woman with a 4-year history …
Competing interests: None declared.