LETTER TO THE EDITOR Dissociation of ferritin and hepcidin in a case of adult-onset Still’s disease Hannah Tharmalingam • Damien R. Ashby • Mark Busbridge • Candice Roufosse • Tom D. Cairns Received: 27 July 2011 / Revised: 17 August 2011 / Accepted: 25 August 2011 Ó The Japanese Society of Hematology 2011 Circulating levels of the iron regulatory hormone hepcidin have been shown to be strongly correlated with ferritin in many studies [1–3]. In a case of adult-onset Still’s disease (AOSD) with striking hyperferritinaemia, we found nor- mal plasma hepcidin suggesting distinct mechanisms of regulation. A 44-year-old woman of African origin presented with sore throat and dyspnoea, preceded by a month’s history of weight loss and night sweats. Examination revealed pyr- exia of 39.7°C, lymphadenopathy, hepato-splenomegaly, bilateral pitting oedema and a maculopapular rash. She was nephrotic, with renal impairment rapidly progressing to dialysis dependence. Renal histology demonstrated focal and segmental glomerulosclerosis, collapsing variant. There were no electron dense deposits, and serological studies for auto-immune, parasitic and viral diseases were negative. AOSD was diagnosed based on Yamaguchi’s criteria [4], and treatment with intravenous immunoglobulin (0.4 g/kg over 5 days) and methylprednisolone (1.5 g over Fig. 1 Clinical response to treatment with intravenous immunoglobulin and methylprednisolone. Serum hepcidin was measured on day 37 and was shown to be within the normal range at 223 lg/L H. Tharmalingam (&) Á D. R. Ashby Á T. D. Cairns Imperial College Kidney and Transplant Institute, Hammersmith Hospital, Imperial College London, London, UK e-mail: hannahtharmalingam@doctors.org.uk M. Busbridge Department of Clinical Biochemistry, Hammersmith Hospital, Imperial College London, London, UK C. Roufosse Department of Histopathology, Hammersmith Hospital, Imperial College London, London, UK 123 Int J Hematol DOI 10.1007/s12185-011-0926-4