Abstract

A 29 year-old woman with a four-year history of adult onset Still’s disease was admitted with fatigue, hypotension, shortness of breath, and lactic acidosis. The patient was steroid-dependent for several years but the initiation of IL-1 blockade with anakinra permitted a steroid taper. Despite treatment with antibiotics for suspected infection, and corticosteroids, the patient developed cardiorespiratory failure and died within 24 hours. All cultures, including blood cultures, were negative. Autopsy revealed dilated cardiomyopathy without evidence of myocardial inflammation. In light of the known association of TNF inhibitors with cardiac death in patients with congestive heart failure, we suggest that clinicians maintain a high index of suspicion for potential cardiac events when treating patients with cytokine inhibitors.