Continued Observations on the Role of Steroid Therapy in Tuberculosis

¹ The Pulmonary Disease Section, Medical Service, Veterans Administration Hospital and the Department of Medicine, University of Buffalo School of Medicine.

1. Steroid therapy has been added to routine chemotherapy in 48 cases of active tuberculosis in an attempt to lower the mortality, shorten the period of toxicity, and improve the overall prognosis.

2. Results have shown a prompt reversal of toxicity, with the patients becoming afebrile, gaining weight and showing a striking rise in hemoglobin values. Sputum conversion has occurred in over 90 per cent of those treated six months or longer. Complications have been few.

3. In addition, x-ray film improvement appears to be accelerated and no adverse radiologic effects have been seen. Whether total improvement exceeds that to be expected without steroid is difficult to evaluate, but seems to occur in some cases.

4. Seven patients have undergone resectional surgery, and two have had thoracoplasties, without difficulty. Drug susceptibility has been retained. The resected specimens show no apparent differences from non-steroid treated cases.

5. This therapeutic combination is of definite value in patients with miliary tuberculosis, tuberculous meningitis, tuberculous pneumonia, and certain other selected cases of far advanced pulmonary disease. While its use in less severe forms cannot be routinely advocated, no harmful effect has as yet been noted in such cases.