Six patients who were treated with corticotropin or high dose adrenal steroid therapy for exacerbations of multiple sclerosis (MS) developed serious and perplexing pulmonary infections. Cavitation and multilobular pneumonia were common. Sputum was scant and physical signs of lung involvement were frequently minimal at the onset. The early signs of the infection may have been masked by the anti-inflammatory drugs, leading to a delay in treatment. Conventional bacterial pathogens were implicated in only a few of the patients, and the response to anti-bacterial therapy was slow and unimpressive. Two patients died of their infection.
Since corticotropin or adrenal steroid therapy do not alter impressively the course of MS, our experience suggests greater caution in selecting patients with this disease for treatment with corticotropin or adrenal steroids.
John M. Sexauer, F. Robert Fekety. Pulmonary Infections Complicating Treatment of Multiple SclerosisOccurrence With Administration of Corticotropin or Adrenal Steroids. Arch Neurol. 1974;30(4):293–295. doi:10.1001/archneur.1974.00490340021003