APPEARANCE OF MILIARY TUBERCULOSIS FOLLOWING THERAPY WITH ACTH AND CORTISONE IN A CASE OF ACUTE DISSEMINATED LUPUS ERYTHEMATOSUS

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Abstract
A case is reported of a 49-year-old woman hospitalized for fever, arthralgia and wt. loss. Investigation for tuberculosis was negative. Disseminated lupus erythematosus was diagnosed on the clinical picture and the finding of LE cells in the bone marrow. There was a prompt remission on ACTH and cortisone. After 14 weeks of cortisone she developed fever, cough and anorexia. On re-hospitalization, miliary tuberculosis was diagnosed, based on chest films and the finding of tubercle bacilli on needle biopsy of lung. Postmortem showed widespread miliary tuberculosis. The literature on the effect of ACTH and cortisone on tuberculosis in animals and man is reviewed. The case supports observations that ACTH and cortisone may aid the dissemination of a tuberculous focus, whether apparent or unsuspected.