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To the Editor:—
Loutfi and Grogan report, in the NEGATIVE RESULTS section, (197:48, 1966) clearing of jaundice and fall in blood bilirubin levels in a patient with extensive metastatic disease of the liver who was given large doses of steroid. When the steroid dosage was reduced the bilirubin level rose sharply and the patient's condition deteriorated rapidly. At autopsy there was much liver hemorrhage and necrosis along with "massive diffuse replacement by metastatic tumor."Curiously, this paper is titled "Failure of Corticosteroid Test in the Differential Diagnosis of Jaundice." The point has been made in several reports (and my own experience tends to corroborate it) that corticosteroid administration may be helpful in differentiating intrahepatic obstructive jaundice from extrahepatic obstructive jaundice. Loutfi and Grogan's patient had an intrahepatic obstructive jaundice, and bilirubin level fell promptly with steroid administration, which is precisely what usually occurs. The response to this test in
Ingegno AP. Obstructive Jaundice And Steroids. JAMA. 1966;197(10):823. doi:10.1001/jama.1966.03110100131044
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