Systemic mycosis complicating high dose corticosteroid treatment of chronic active liver disease

S. H. Wright, A. J. Czaja, R. S. Katz, R. D. Soloway

Research output: Contribution to journalArticle

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Abstract

Four patients with severe chronic active liver disease, treated with 30-200 mg. of prednisone daily for one-half month to seven months because of lack of response to smaller doses, developed systemic mycosis. Presentation was variable, consisting of cryptococcal meningitis, cryptococcal pneumonia, aspergillus cerebral vasculitis and disseminated histoplasmosis originating from a histoplasma pneumonia. None of 114 patients in the Mayo Clinic trials on conventional treatment for at least six months, but only one of 25 patients (4%) on high dose prednisone, developed systemic mycosis. Low dose prednisone or its equivalent can be maintained to control hepatic inflammation during vigorous antifungal therapy without jeopardizing cure of the fungal infection. We conclude that systemic mycosis is infrequently associated with corticosteroid therapy for severe chronic active liver disease but can occur on high dose regimens as a subtle, progressively debilitating and potentially fatal complication that justifies prompt recognition and aggressive treatment with amphotericin-B alone or in combination with 5-fluorocytosine.

Original languageEnglish (US)
Pages (from-to)428-432
Number of pages5
JournalAmerican Journal of Gastroenterology
Volume74
Issue number5
StatePublished - 1980
Externally publishedYes

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Mycoses
Liver Diseases
Adrenal Cortex Hormones
Prednisone
Pneumonia
Central Nervous System Vasculitis
Cryptococcal Meningitis
Histoplasma
Flucytosine
Histoplasmosis
Amphotericin B
Aspergillus
Therapeutics
Inflammation
Liver

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Systemic mycosis complicating high dose corticosteroid treatment of chronic active liver disease. / Wright, S. H.; Czaja, A. J.; Katz, R. S.; Soloway, R. D.

In: American Journal of Gastroenterology, Vol. 74, No. 5, 1980, p. 428-432.

Research output: Contribution to journalArticle

Wright, S. H. ; Czaja, A. J. ; Katz, R. S. ; Soloway, R. D. / Systemic mycosis complicating high dose corticosteroid treatment of chronic active liver disease. In: American Journal of Gastroenterology. 1980 ; Vol. 74, No. 5. pp. 428-432.
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