Corticosteroids are the physician’s immunomodulatory agent of choice. These agents are inexpensive and ubiquitously available, have a well-known adverse effect profile, do not require monitoring of drug levels, and, probably most important, mimic the body’s own response to stress. Accordingly, corticosteroids have been used for a wide variety of medical illnesses. Use of corticosteroids for acute illness has always been controversial, no more so than for treating the triad of community-acquired pneumonia,1 septic shock,2,3 and acute respiratory distress syndrome.4,5