Study of Pulmonary Tuberculosis following Corticosteroid Therapy

Six patients who developed tuberculosis during corticosteroid therapy were reported. The indications for corticosteroid therapy were : SLE, idiopathic thrombocytopenic purpura, pemphigus vulgaris, radiation pneumonitis, renal transplantation, and autoimmune hemolytic anemia. There were 4 men and 2 women ranging in age from 49 to 76 years (mean 61 years). The duration of corticosteroid therapy ranged from 1 to 11 months (mean 4 months). The full dose of corticosteroid ranged from 1750 to 2890mg of prednisolone equivalent (mean 2350mg). Initial symptoms were fever in six patients, cough and sputum each one patient. At the time of diagnosis, 5 patients had a negative tuberculin skin test. The diagnosis of tuberculosis was established by positive smears for acid fast bacilli of sputum in 5 patients, and by transbronchial lung biopsy in one patient. The chest radiograph at the time of diagnosis showed cavitary lesion in 3 instances and disseminated lesion in 3 instances. Two patients died directly from tuberculosis. 4 patients recovered with antituberculosis chemotherapy. The conversion time ranged from 1 to 4 months (mean 2.5 months). It was concluded that in all patients during corticosteroid therapy, regular clinical, bacteriological and radiological review should be essential.