TREATMENT OF TUBERCULOUS PLEURAL EFFUSIONS WITH PARTICULAR REFERENCE TO ADRENAL CORTICOSTEROIDS

On the basis of our own experience with tuberculous pleural effusions in children as well as on the more extensive experience of other clinicians working with adult patients, we believe that adrenal corticosteroids, given simultaneously with adequate antituberculous drug therapy, not only exert no deleterious effect on the underlying tuberculous infection, but frequently hasten clinical and roentgenographic improvement. Six consecutive patients with tuberculous pleural effusions are here presented. Diagnosis was established with the aid of tuberculin test, cultures of gastric washings and pleural fluid, and pleural biopsy. Treatment included administration of INH, PAS and prednisone. The clinical and roentgenographic response was unusually prompt in the five patients with early effusions. On the basis of this experience we recommend the following treatment: INH (20 mg/kg/24 hr) for a period of at least a year, PAS (0.5 gm/kg/24 hr) for the same length of time; and prednisone (1.0 mg/kg/24 hr) for a period of about 4 to 6 weeks, with diminishing doses during the ensuing 2 weeks. The general care should be that given to any child with early active tuberculosis, including bed rest during the febrile period but rarely beyond it. If such treatment can be instituted early, the incidence of pleural adhesions, with ventilatory impairment and development of scoliosis, is probably lessened. The sixth patient, who was suffering from fibrocaseous pleurisy at the time of admission to our hospital, recovered slowly; in this case adrenal corticosteroid therapy appeared to exert no effect on the course of the disease.