Hepatic, cutaneous and hematologic manifestations in juvenile chronic arthritis

Two patients suffering from systemic onset juvenile chronic arthritis (JCA) with a polyarticular course developed an acute illness shortly after commencing a new second line drug (gold and penicillamine). The clinical picture consisted of fever, rash, lymphadenopathy and hepatomegaly with elevated liver enzymes and hematological changes. The possible relationship of the disease to second line drugs is discussed.