Clinical analysis of pulmonary tuberculosis in association with corticosteroid therapy

Due to the increased incidence of pulmonary tuberculosis in association with corticosteroid therapy during the last five years in our associated hospitals, we studied the clinical characteristics of these patients.

Fourteen cases of pulmonary tuberculosis were collected which occurred in association with corticosteroid drugs in our associated hospitals during the last 10 years; four patients (2.1%) from April 1991 to March 1996 and 10 patients (4.3%) from April 1996 to March 2001.

The average age of the 14 patients was 74.1 years old and the male:female ratio was 9:5. Regarding underlying diseases, respiratory diseases (7 patients) were the most frequent and a past history of pulmonary tuberculosis was recognized in six patients. The duration of corticosteroid administration ranged from two months to seven years and the total dose of corticosteroids ranged from 1.20 g to 12.05 g. Pulmonary tuberculosis was detected by chance during a health examination in eight patients and radiological findings showed an infiltration shadow without cavity located in a portion other than the predominant location in four patients. A microbiological examination was smear positive in eight patients but tolerance was not shown to any antituberculous drugs. The prognosis was poor because the mortality rate was high, but the cause of death was not related to the progress of pulmonary tuberculosis.

Careful observation of patients is considered to be important because pulmonary tuberculosis in association with corticosteroid drugs was found among inpatients, there was no relationship to the total dose or duration of administration of corticosteroid drugs, there were no clinical symptoms, and the patients exhibited atypical radiographic findings.