Case History:
A 43-year-old female with a known history of Still’s Disease, since 2020, presented with her fourth flare-up characterized by high-grade fevers and acute severe hepatitis in June 2024.
Her initial diagnosis three years ago led to treatment with Tocilizumab (Actemra) and steroid therapy, which controlled her symptoms until she became steroid-dependent and unresponsive after six doses. Her first flare-up in July 2021 involved a high-grade fever and elevated liver enzymes, followed by a second flare-up six months later, presenting with a high-grade fever and a diffuse salmon-colored rash as shown in [figure 1].