Cyclosporine Offers Breakthrough for Rare Anemia in Still's Disease

Pure red cell aplasia (PRCA) is a very rarely seen complication of Adult-onset Still's disease (AOSD). Due to the scarcity of documented cases, the medical community's understanding of PRCA's typical course and response to treatment within the context of AOSD remains limited, posing significant challenges for affected patients.

This challenge was starkly illustrated in the case of a 36-year-old woman with AOSD complicated by severe PRCA. Treatments for her underlying Still's disease, including glucocorticoids, IL-1 inhibitors, and tocilizumab, improved the clinical features of her disease; however, her severe, transfusion-dependent anemia persisted.

The initiation of cyclosporine marked a turning point in her treatment. As lead author Wikoff notes in the paper, "The initiation of cyclosporine led to rapid remission of the PRCA." This successful outcome is particularly significant as it points to a potential therapeutic pathway for a severe complication that, in this instance, proved resistant to initial conventional treatments. This case provides valuable data for clinicians facing similar rare and challenging presentations, suggesting cyclosporine as a viable option when other therapies prove ineffective for AOSD-associated PRCA.