Massive Doses of Cortisone in the Control of Acute Lupus Crisis in Systemic Lupus Erythematosus

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WE have reported elsewhere1 the life-saving effect of massive dosages of cortisone and/or ACTH in the acute lupus crises which have, in the past, fatally complicated the course of systemic (acute or subacute disseminated) lupus erythematosus. The present brief report further exemplifies the value of this treatment. It also records the largest doses of cortisone yet given. A rationale for such treatment is suggested also.

Case Report

A 12 year old girl was admitted to the Cleveland Clinic on August 22, 1950, complaining of joint pains of 6 months' duration, and of chills, fever, malaise and weight loss as well as a rash over the bridge of her nose which had been present for 3 weeks. A positive L.E. test2 confirmed the diagnosis of acute systemic lupus erythematosus.

The clinical manifestations subsided under treatment with cortisone supplemented briefly with ACTH. She was discharged for home care on a maintenance dosage of 50 mg. of cortisone administered orally twice a day, a low sodium diet (0.5 Gm. sodium) and 3 Gm. of potassium chloride daily. Joint pains and malaise recurred in about 2 weeks and, during the next 3 months, were checked only by means of gradually increased doses of cortisone, finally approximating a total of 170 mg. daily.

Because of this difficulty the patient was readmitted with the purpose of re-establishing control with ACTH. Treatment with ACTH (120 to 160 mg. daily) and gradually diminishing doses of cortisone (300 to 60 mg. daily) was begun in divided doses on the. . .



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