Liver biopsy is not useful in the diagnosis of adult Still's disease

Sir, Liver biopsy is usually the most specific test to assess the nature and the severity of numerous liver diseases (reviewed in reference 1). In addition, it can be useful in diagnosing or monitoring chronic fever or several inflammatory disorders, particularly in case of liver abnormalities.2 However, it is debatable whether this examination has any utility in the diagnosis or management of Still's disease in adults. We performed percutaneous liver biopsy in five patients with a retrospectively established diagnosis of adult Still's disease, with regard to Yamaguchi's criteria.3 All five patients were febrile, had evanescent maculopapular rash, leukocytosis and chronic liver abnormalities, particularly moderate hepatomegaly and high serum alanine aminotransferase levels (between 2‐ and 5‐fold the normal level) (partial data in reference 4). In all the patients, percutaneous liver biopsy was done under local anaesthesia and controlled by ultrasonography. No major complications were reported. Transient localized pain at the biopsy site was observed in two patients, requiring low paracetamol doses.